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Coder-Risk Adjustment

Finance / Accounting

Remote

ID:2015025

Full-Time/Regular

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Coding Validation Program Coder manages the day-to-day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic data base and or excel spread sheets.

The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. The coder will respond to interdepartmental and provider inquiries guaranteeing that all work is in compliance with internal and external protocols and compliance requirements.

Responsibilities

• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Ability to code government and state models. This includes code everything projects.
• Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
• Ability to maintain a 95% accuracy rate on all coding projects.
• Handle other related duties as required or assigned.
• Coders assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.

Requirements

• Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
• Strong organizational skills
• Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel and Outlook.
• Strong written and verbal communication skills
• Ability to work independently in a remote environment.
• Private lockable office space to ensure security of Member PHI
• Minimum of 5 years coding experience with at least 3 of those years in Risk Adjustment coding.
• High School Diploma
• Completion of an accredited medical coding program with current unencumbered credentials.

Required education:

• High School Diploma
• CPC/CRC Certification

Required experience:

• Risk Adjustment coding: 3 years
• Coding: 5 years

Supervision Received

• General supervision is received weekly.

Medical Coder

Remote 

Operations Revenue Cycle

Full-Time

Remote

As a physician-founded and led organization, ensuring everyone has access to quality healthcare is what inspires us. That’s why we hire people who genuinely care about patients, solving healthcare challenges, and making a positive impact every day. Join us and help change the future of healthcare for the better.

120+ locations and growing, along with vast virtual coverage

1 million+ patients to-date

2,000+ caring clinicians and support staff serving their communities

Backed by investors such as CVS Health Ventures and Blackstone Horizon

This role will be responsible for reviewing medical record documentation for accurately assigning diagnostic and procedural coding relative to revenue and reimbursement for all encounters associated with Carbon Health entities. This will also include translating patient information into alpha-numeric medical codes using patient treatment, health history, diagnosis, and related information. ICD-10-CM and CPT code assignments must be consistent with CMS’Official Guidelines and any regulatory agency guidelines. We will look to your knowledge of CPT, ICD-10 coding guidelines, compliance and professional billing practices; including knowledge of Evaluation and Management Guidelines to coordinate with Coding Leadership to identify provider education and revenue opportunities.

What You’ll Do

• Complete accountable work related to pended charges in work queue review to ensure timely billing in conjunction with billing and compliance guidelines
• Select correct code assignment by proficient analysis and translation of diagnostic statements, physicians’s orders, and other pertinent documentation
• Responsible for keeping abreast of current ICD-10 and CPT coding guidelines and regulatory guidance; including responsibility for maintaining current coding certification status
• Participates in process improvement assignments and other duties as assigned incoordination with billing for documentation review as needed for rebill and appeals

About You

• 4+ years coding experience, billing for professional services, and related experience
• Associate degree in related field or equivalent experience may be substituted
• Current AAPC Certified Professional Coder (CPC) certification
• Expertise of Coding and Billing Guidelines for multiple specialties
• Technical knowledge and skills of electronic medical records

Perks

Forward-thinking, transparent, and inclusive company culture

Competitive salary, generous paid time off, learning time off, and paid holidays

Comprehensive benefits package including medical, dental & vision insurance

401k employee contributions, FSA, HSA, and dependent care options

Employee referral bonus program, employee resource groups, and professional development

All benefits dependent on role and eligibility

All candidate email communication will be done through an @carbonhealth.com email address. If you ever receive communication regarding a job posting from an entity that does not match that or seems concerning, please contact [email protected].

Carbon Health is a leading national healthcare provider with a mission to make high-quality healthcare accessible to everyone. We offer primary and urgent care to nearly two-thirds of the U.S. Leveraging our unique technology platform, we meet patients where they are by delivering care across a variety of access points, including in-person clinics and virtual care. Carbon Health also focuses on value-based care and other value-add services to employers, health plans, health systems and other ecosystem partners.

We recognize that the key to success lies in valuing the minds, experiences and perspectives of people from all walks of life. Carbon Health is proud to value ersity and be an equal opportunity employer. Pursuant to the San Francisco Fair Chance Ordinance and the Los Angeles Fair Chance Initiative for Hiring, we will consider for employment qualified applicants with arrest and conviction records. Carbon Health is an E-Verify employer.

Subject Matter Expert-Complementary and Alternative Medicine in Advanced Practice Nursing

Job Category: RAS Adjunct

Requisition Number: SUBJE004909

Posting Details

• Part-Time
• Locations: Online / Remote

Job Details

Description

Subject Matter Expert– Complementary and Alternative Medicine in Advanced Practice Nursing

Rasmussen University

ABOUT RASMUSSEN UNIVERSITY:

Rasmussen University is a regionally accredited private university dedicated to changing lives and the communities it serves through high-demand and flexible educational programs. As a pioneer in career-focused education since 1900, the University is defining a new generation of higher education that focuses on competency-based education, technology and transferrable skills. Rasmussen offers undergraduate and graduate programs online and in person at 23 campuses around the country. The University is designed to lift and support its students every step of the way, from their first credential to their last. Rasmussen is dedicated to global enrichment, serving the underserved and meeting the evolving needs of erse students, communities and economies. Rasmussen encourages its students, faculty and staff to strive for academic excellence, community enrichment and service to the public good. For more information about Rasmussen University, please visit www.rasmussen.edu.

Competencies in Complementary and Alternative Medicine in Advanced Practice Nursing Course:

• Differentiate the types of massage therapy techniques.
• Compare types of Chinese Medicine that can be incorporated into the comprehensive plan of care for patients across the lifespan.
• Assess the potential impact of herbal and supplemental therapies in health promotion and disease management for primary care patients.
• Create a treatment plan using the principles of homeopathic medicine for primary care patients across the lifespan.
• Evaluate concept of mind and body therapies to address health challenges for patients in a primary care setting.
• Develop a treatment plan that involves elements of functional medicine for primary care patients across the lifespan.

Reporting Relationships:

Subject Matter Experts (SME’s) will act as Contractors assigned to collaborate with the appropriate school curriculum and course experts.

Position Summary:

Participate in a Kickoff call

All Subject Matter Experts (SMEs) are expected to participate in a kickoff call with the appropriate Development Owner. The goal of the call is to create a shared vision for the course, discuss any special considerations, and get started on mapping out the course.

Produce raw content for the following deliverables:

• SME Development Template.
• CBE (competency-based education) for course content depending on the course’s program.
  • Suggestions for assessments, learning activities, and rubric criteria.
  • Video scrips and storyboards.
  • Supplemental content in support of learning outcomes.
  • Multimedia development suggestions.
  • Notes/answer keys/ teaching suggestions to be included as a Faculty Guide.
• Test Outs as necessary.

Produce original instructional materials for online learning

Subject Matter Experts are hired to provide expertise in the subject area. As such, we are looking to the SME to provide original content and not only rely solely on the textbook or publisher materials.

This content should:

• Translate expected learning outcomes into instructional material that allows students to achieve weekly learning outcomes.
• Meet Rasmussen’s course development style standards.
• Be checked for accuracy and consistency of spelling, grammar, and other mechanical and style issues before submission.
• Incorporate constructive feedback into online tests, exams, and quizzes. If necessary, provide feedback prompts to other non-objective assignments that instructors can use when teaching the course

Deliver the content using the appropriate templates

The content development template provides content that can be directly translated into the finished course. What you see in the document is what will appear in the course.

Deliver the content in a timely manner

There are many people involved in the creation of an online course. Each is dependent on the others to have their part completed by a certain time; therefore, it is imperative that delivery milestones are met.

Participate in regular review sessions with the Development Owner

The Development Owner will be regularly reviewing the work submitted by the SME. Hence, the SME must be available for a regularly scheduled feedback call or email with the Development Owner. Development Owner and SME will come to an agreement on the time, frequency, and form of these communications.

You are responsible for a finished product. Do your best to submit your most polished effort, rather than a rough draft. Your Development Owner will support you in these efforts.

Be an available resource

The SME is expected to be an available resource throughout the entire course development process.

After the design phase, the course is turned over to our Instructional Design team to review the content the SME has developed.

Fulfill all the above responsibilities

SME must fulfill all the stated responsibilities for a positive collaboration.

Credentials:

• Terminal Degree in Nursing with area: PMHNP, AGNP, FNP or PNP
• 2+ years teaching at the graduate level
• Strong Communication/Writing skills

Location:

This position is remote but not available to CO residents

Washington and NYC Pay Transparency Statement:

If you are a Washington or New York City resident and this role is available remotely, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request. Please send an email to [email protected]

At Rasmussen, we are proud to be an equal opportunity employer. We are committed supporting and encouraging ersity in the workplace. We welcome our employee’s differences regardless of race, color, creed, religion, gender, national origin, sexual orientation, marital status, age, gender identity, disability, or veteran status.

Title: Deal Strategy Manager

Location: Remote, USA

Omada Health is on a mission to inspire and engage people in lifelong health, one step at a time.

Job overview:

As part of our growing Commercial Operations function at Omada, the Deal Strategy Manager will play a critical role in supporting Omada’s Commercial team by leading the process around crafting winning responses to all proposal requests to Omada. This role will be instrumental in supporting sales opportunities with our enterprise customers, partners, and health plans by collaborating with the Sales team to deliver timely and high quality bids.

About you:

As a Deal Strategy Manager, you are the go-to person for all inbound bid requests. The Deal Strategy Manager will be responsible for driving the execution of winning bids, in line with the commercial strategy and goals. You will oversee all aspects of proposal preparation, ensuring quality, and making sure compelling bids are submitted in a timely manner. You will become an expert in Omada’s products and value proposition so that it is reflected in all of our bid activity. You will be a key partner to the Sales leadership team in determining how and when we respond to what bids, and with what priority.

Specific duties include:

• Works with key stakeholders to identify win themes, sales strategy approach, and a work plan, to complete pursuit activities.
• Engages with Omada sales leaders, executives, and SME’s to ensure necessary support for bid efforts.
• Drives effective collaboration with all partners involved in the pursuit.
• Tracks progress of the pursuit effort and routinely reports status to Commercial Effectiveness and Sales Management.
• Directs support resources assigned to the creation, editing and production of presentations, proposal and contract documentation.
• Ensures pursuit activities are conducted in compliance with Omada’s policies.
• Ensures all pertinent knowledge artifacts from bid effort are captured and appropriately archived for future reference.
• Participates in Win / Loss Reviews and captures key lessons learned.

You will love this job if you:

• A highly effective communicator, both written and verbal
• A cross-functional team member who is able to work with internal stakeholders to ensure alignment between internal teams and Commercial teams
• Highly organized with exceptional time management skills
• Industrious with a collaborative working style
• Passionate about creating and scaling an end to end sales process
• Passionate about supporting a mission to improve healthcare through innovation and technology!

Bonus points for:

• Experience in the healthcare space and/or partner sales

Benefits:

• Competitive salary with generous annual cash bonus
• Stock options
• Remote first work from home culture
• Flexible vacation to help you rest, recharge, and connect with loved ones
• Generous parental leave
• Health, dental, and vision insurance (and above market employer contributions)
• 401k retirement savings plan
• Work from Home stipend
• Two giftable Omada enrollments per calendar year
• …and more!

It takes a village to change health care. As we build together toward our mission, we strive to embody the following values in our day-to-day work. We hope these hold meaning for you as well as you consider Omada!

• Start with Trust. We listen closely and we operate with kindness. We provide respectful and candid feedback to each other.
• Seek Context. We ask to understand and we build connections. We do our research up front to move faster down the road.
• Act Boldly. We innovate daily to solve problems, improve processes, and find new opportunities for our members and customers.
• Deliver Results. We reward impact above output. We set a high bar, we’re not afraid to fail, and we take pride in our work.
• Succeed Together. We prioritize Omada’s progress above team or inidual. We have fun as we get stuff done, and we celebrate together.
• Remember Why We’re Here. We push through the challenges of changing health care because we know the destination is worth it.

About Omada Health: Omada is a virtual-first chronic care provider that nurtures lifelong health, one day at a time. Our care teams implement clinically-validated behavior change protocols for iniduals with prediabetes, diabetes, hypertension, and musculoskeletal issues for consistent improvements that stack up. With more than a decade of experience and data, and 24 peer-reviewed publications that showcase our clinical and economic results, we improve health outcomes and help contain healthcare costs.

Our scope exceeds 1,800 customers, including health plans, health systems, and employers ranging in size from small businesses to Fortune 500s. Omada is the first virtual provider to join the Institute for Healthcare Improvement’s Leadership Alliance, reflecting our aim to complement primary care providers for the benefit of our members, and affirming our guarantee to every partner: Omada works different.

Omada is thrilled to share that we’ve been certified as a Great Place to Work! Please click here for more information.

We carefully hire the best talent we can find, which means actively seeking ersity of beliefs, backgrounds, education, and ways of thinking. We strive to build an inclusive culture where differences are celebrated and leveraged to inform better design and business decisions. Omada is proud to be an equal opportunity workplace and affirmative action employer. We are committed to equal opportunity regardless of race, color, religion, sex, gender identity, national origin, ancestry, citizenship, age, physical or mental disability, legally protected medical condition, family care status, military or veteran status, marital status, domestic partner status, sexual orientation, or any other basis protected by local, state, or federal laws.

Below is a summary of salary ranges for this role in the following geographies:

California, New York State and Washington State Base Compensation Ranges: $121,600 – $152,000*, Colorado Base Compensation Ranges: $109,440 – $136,800*. Other states may vary.

This role is also eligible for participation in annual cash bonus and equity grants.

*The actual offer, including the compensation package, is determined based on multiple factors, such as the candidate’s skills and experience, and other business considerations.

Please click here for more information on our Candidate Privacy Notice.

Account Resolution Specialist – REMOTE

Status (FT/PT): Full-Time

Shift: Day shift

Req ID: 56862

Description

Find more than your next job. Find your community.

• We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development.
• After work, you’ll find things to do in every season beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

Summary:

Acts as a resource to ensure patient accounts are accurate and handled appropriate for: prior authorizations, Acts as a resource for collection issues. Is responsible for a variety of collections processes, including but not limited to: performing general collection functions; keeping abreast of trends and/or regulation changes in collections process; and sending, verifying, and balancing on-site collections.

Why work as an Insurance Verifier at Munson Healthcare?

• Offers a remote work schedule
• Our dynamic work environment includes many opportunities for growth and development
• Be a part of a team that nurtures a culture of caring every day
• Our employees work in positive, supportive, and compassionate environments built on our organizational values.

What’s Required:

• High school graduate or equivalent required. Post high school education preferred.
• Two to three years medical billing and collection experience, with understanding of medical insurance product guidelines.
• Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with erse populations.

The Benefits of Working at Munson:

• Competitive salaries
• Full benefits, paid holidays, and paid time off (up to 19 days your first year)
• Tuition reimbursement and ongoing educational opportunities
• Retirement savings plan with employer match and personal consulting
• Wellness plans, an employee assistance program and employee discounts

Assistant Nurse Manager (Remote)

Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a Series B startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).

The ideal teammate would be

• A nursing leader who is passionate about caring for our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance
• Someone who has a proven track record of using data to drive high quality and efficient clinical outcomes
• Someone who ideally has experience in chronic care management, remote patient monitoring, and valuable based care of vulnerable populations
• Love learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together
• Comfortable working in an ambiguous environment within an organization that is growing and changing quickly
• Enjoy moving back and forth between direct care management with members when needed to helping us build out a care management program
• Curious about changing regulations within the space and how they can be leveraged to create additional revenue streams

The ideal teammate would be able to:

• Provide leadership, coaching, and development to a team of nurses and other multidisciplinary iniduals performing care management
• Identify inefficiencies and opportunities for quality improvement. Create process improvement to achieve member and clinician satisfaction
• Partner with Vesta’s data analytics team and clinical leadership to develop ongoing reporting and analysis to drive the efficiency, quality, and effectiveness of the clinical team and outcomes
• Serve as a subject matter expert for chronic care management (CCM), Transitions of Care (TOC) and remote patient monitoring (RPM)
• Continue to push the boundaries of what technology can do to empower our caregivers and clinicians to improve health outcomes for our patients
• Support the development of strategies to help scale the program. Assist in evaluating capacity planning, hiring, training, and measuring and managing productivity including creating operational metrics and benchmarks
• Collaborate with cross departmental leads in analytics, product/engineering and business operations to drive efficiencies and quality improvement
• Assist manager with making sure team is appropriately staffed and find coverage when needed
• Assist in implementing new clinical programming across our clinical PODS
• Support team to address escalated member challenges
• Perform direct care management activities as assigned

Would you describe yourself as someone who has:

• Registered Nurse with unrestricted license within NY and/or compact with ability to obtain additional licenses within 1 month (required)
• Bachelor’s degree from an accredited institution (preferred)
• 4+ years of nursing experience within acute care, care management, and/or homecare (required)
• 2+ years of experience leading/managing a clinical team overseeing several complex projects simultaneously (required)
• Experience managing a remote team (preferred)
• Passionate about our mission to improve people’s lives
• Digital health or hybrid digital health experience (preferred)
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

In addition to amazing teammates, we also offer:

• Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
• Paid vacation
• Paid Sick/personal days
• 12 paid holidays
• One time reimbursement to set up your home office
• Monthly reimbursement for internet or other home office expenses
• Monthly gym reimbursement to be used for gyms, home equipment, online classes, etc
• Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
• Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
• Pre-tax Flex Spending/Dependent Care/Transit accounts
• 401k + match

Pay range is $90K – $101K annually plus bonus. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

If yes, then we look forward to speaking to you!

Utilization Review Nurse- PRN Weekends Only (Sat/Sun)

locations

Remote – Other

time type

Part-time

job requisition id

R011500

Do you perform admission and/or continued stay reviews in a hospital setting? Do you have five years of hospital acute care nursing experience? Are you looking for a remote opportunity?

We are seeking a candidate who has a proven record of conducting UR reviews in an acute hospital setting using InterQual. The ideal candidate must have at least 5 years of acute care experience in a hospital setting (OR, ER, ICU, MedSurg, Tele, NICU, Peds, Ortho) and at least 3 years of UR doing admission reviews and/or continued stay reviews in an acute hospital setting.

The Utilization Review RN requires a quick onboarding process to consult for our clients at the assigned facilities.

Responsibilities

• Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual.
• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 3 years case management, concurrent review or utilization management experience
• Experience with InterQual criteria
• Proficiency in medical record review

Preferred

• Case management/concurrent review/utilization management experience within the ED setting
• Bachelors of Science in Nursing

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.
• Hours will vary, including two weekends a month.
• Must be able to remain in a stationary position 50% of the time and constantly operate a computer.
• Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all iniduals. We celebrate ersity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmart’s third party screening provider.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Global Therapist (Contractor)

Our mission: We’re on a mission to help iniduals and organizations thrive by eliminating every barrier to mental health. Spring Health is the leading comprehensive mental health benefit for employers. We help employees understand their mental health issues and connect with best-in-class providers to get the right treatment at the right time. From early detection to full recovery, Spring Health is the only clinically validated solution in the market proven to be more effective than traditional mental healthcare. By combining the latest technology with vetted providers, we help engage 1 in 3 employees, reduce recovery times, and lower healthcare costs. We are an award-winning, passionate, and mission-driven team with the support of leaders in psychiatry. We are seeking qualified, part-time internationally licensed psychotherapists to join our provider network and deliver care with a tech-enabled, AI/machine-learning platform that puts patient outcomes first.

What You’ll Do:

• Provide counseling to clients with benefits ranging from short-term goal-focused EAP, to employer health plans allowing many sessions as medically necessary.
• Treat adults who have completed brief, evidence-based online screenings identifying their symptoms and areas of concern.
• Preferably, also be open to treating additional populations such as children, adolescents, couples, or families.
• Maintain a calendar displaying your availability and complete session documentation in a timely manner within our scheduling system.
• Use evidence-based treatment modalities and interventions that are tailored to your client’s needs.
• Collaborate with our dedicated provider support team, our licensed clinical care navigation team, and our administrative care support team whenever you need assistance.
• Provide culturally competent and empathetic care, upholding our values of ersity and inclusion for all races, ethnicities, and genders.

Who You Are:

• You have an unrestricted license to practice counseling (Psychologist, Masters level counselor, etc.) in a country outside of the United States. We are not able to accept applications from anyone requiring licensed supervision.
• Post-graduate experience with at least 1 year of post-licensed experience.
• You’re comfortable with technology and are telehealth competent.
• You have training and experience in evidence-based modalities of care such as CBT, DBT, EMDR, ACT, CPT.
• You are comfortable with providing safety planning and intervention during situations where a client might present with higher risks.
• You are committed to quality clinical care and want to expand your capabilities and increase your effectiveness by being informed of client progress or challenges.
• You like working independently, but would also enjoy having the support of a team and opportunities for connections and collaboration with other providers and our master’s level clinical care navigators.

• You’ll set your own schedule to fit your professional and personal needs.
• Work from anywhere, as long as you have a confidential, private location with stable internet.
• No need to spend time marketing your practice, checking insurance eligibility, collecting fees, or submitting claims—we take care of the administrative work so that you can focus on clinical care.
• Grow your ability to provide effective care through feedback from evidence-based measures that help you identify what is working with your clients.
• Join a dynamic community where you will be supported, your work appreciated, and you’ll have the opportunity to help us shape the future of mental health care!

In addition to finding people who are truly excellent at what they do, we take our values at Spring Health seriously:

Members Come First We are genuine member advocates.

Move Fast to Change Lives We build with urgency and intention.

Take Ownership We extend trust and hold ourselves accountable.

Embrace Diverse Teams & Perspectives We find strength in the ersity of cultural backgrounds, ideas, and experiences.

Science Will Win We will achieve impact by innovation and evidence based frameworks.

Candor with Care We are open, honest and empathetic.

Compliance Operations Manager

Location: US-TX-Dallas Requisition ID: 2023-11041 Job Category: Health Strategies Additional Locations Diversity Distribution US – Top 57 Position Type: Full Time

Overview

Now is the time to join us and make a difference. Be a relentless force for a world of longer, healthier lives. Here at the American Heart Association, you matter and so does your career.

The American Heart Association has an excellent opportunity for a Compliance Manager in our Quality, Outcomes Research & Analytics (QORA) department!

This position can be home based.

The Association offers many resources to help you maintain work-life harmonization through your changing needs and life situations. To help you be successful, you will have access to Heart U, our award-winning corporate university, as well as additional training and support, locally.

Responsibilities

The Compliance Audit Manager is responsible for planning, coordinating and implementing all activities pertaining to clinical data quality audits in order to protect the integrity and credibility of the American Heart Association and the representations that we make to the public. They will ensure that the data acquired from patient records gathered in the patient registry are consistent with audit standards used to measure the Get With The Guidelines (GWTG) and/or other quality recognition programs. The incumbent reports to the Senior Manager, Registry Research. The incumbent works with the Quality Senior Team, Internal Audit, Legal and other departments, when required; and follows departmental policies and procedures as well as limited instructions in carrying out daily compliance tasks. The Department’s vision is to build a fully developed clinical data quality audit function that proactively delivers valuable results to the Quality and Health IT department and its Volunteers. This position will also lead the Risk Control Self-Assessment (RCSA) of the department’s risks and provide mentorship to implement appropriate controls; as well as be responsible for other areas that require compliance oversight, including but not limited to business agreements with hospitals and business partners. This is accomplished by evaluating risks in achieving organizational objectives and proposing value-added and efficient measures for controlling and leading those risks. Assisting management by reviewing the organization’s operations, the adequacy of internal controls, the compliance with laws and regulations, the adherence to policy and procedures, the safeguarding of assets, and the accuracy of reported financial activities. Supporting governance by assuring the organization about the state of the control environment.

Build a network of meaningful volunteer partnerships to advance the mission of the American Heart Association/American Stroke Association. Provide timely direction, framework and resources to volunteers while at the same time relying on their expertise, abilities and willingness to demonstrate their networks to drive the goals of the organization. Share meaningful opportunities for volunteers, so they can apply their passion to further the mission of the organization. Give recognition to volunteers for their efforts to help ensure their success and drive happiness. Hold each other accountable, both volunteers and staff, while being accessible and build collaborative staff-volunteer partnerships that are based on a foundation of mutual trust. Build a collaborative environment where staff from various functions work together to achieve results across health, revenue and volunteerism goals for the organization.

• Conducts on-site and remote audits of hospitals participating in quality programs and research
• Facilitate audit by leading all aspects of the project management of specified activities
• and ensuring the audit process is carried through to completion
• Develop data quality and clinical research audit plans, including objectives, testing criteria for how audits shall be conducted. Ensures staff are implementing process changes that appropriately address audit findings
• Conduct abstractor training, IRB activities, and other duties as assigned to support research efforts
• Communicate audit protocols and findings expertly and effectively with consultants, clinical directors, senior management, clinicians, and colleagues, internally and at all levels in external organizations
• Lead department Risk Control Self-Assessment (RCSA) by reviewing adequacy of internal controls and assist management by reviewing the organization`s operations, the adequacy of internal controls, the compliance with laws and regulations, the adherence to policy and procedures, the safeguarding of assets, and the accuracy of reported financial activities

Qualifications

• Bachelor’s Degree and/or Registered (RN) and/or Certification in Healthcare Research Compliance and/or Certified Professional Coder – Hospital (CPC-H)
• Two (2) – Five (5) years of proven experience
• Experience with clinical setting or clinical trials or utilization reviews
• Knowledge of laws and regulations i.e. HIPPA, PHI
• Communicate expertly and optimally with healthcare professional
• Microsoft Office proficiency
• Project Management experience
• Strong interpersonal/relationship building skills
• Some travel will be required

Preferred Experience:

• Health IT data audit Experience

Compensation & Benefits

The American Heart Association invests in its people. Here are the main components of our total rewards package. Visit Rewards & Benefits to see more details.

• Compensation Our goal is to ensure you have a competitive base salary. That’s why we regularly review the market value of jobs and make adjustments, as needed.
• Performance and Recognition You are rewarded for achieving success by merit increases and incentive programs, based on the type of position.
• Benefits We offer a wide array of benefits including medical, dental, vision, disability, and life insurance, along with a robust retirement program that includes an employer match and automatic contribution. As a mark of our commitment to employee well-being, we also offer an employee assistance program, employee wellness program and telemedicine, and medical consultation.
• Professional Development You can join one of our many Employee Resource Groups (ERG) or be a mentor/mentee in our professional mentoring program. HeartU is the Association’s national online university, with more than 100,000 resources designed to meet your needs and busy schedule.
• Work-Life Harmonization The Association offers Paid Time Off (PTO) at a minimum of 16 days per year for new employees. The number of days will increase based on seniority level. You will also have a total of 12 paid holidays off each year, which includes several days off at the end of the year.
• Tuition Assistance – We support the career development of all employees. This program provides financial assistance to employees who wish to further their education and career in relation to their current duties and responsibilities, or for potential future positions in the organization.

The American Heart Association’s 2024 Goal: Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the American Heart Association will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.

At American Heart Association | American Stroke Association, ersity, inclusion, and equal opportunity applies to both our workforce and the communities we serve as it relates to heart health and stroke prevention.

Benefit Administration Product Specialist

Product Management

Remote

ID:2015020

Full-Time/Regular

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Benefit Administration Product Specialist is responsible for day-to-day benefit/product administration operations, ensuring the alignment of business processes and decisions with the benefit/product strategy as well as ensuring compliance from a benefit perspective including the development and management of Evidence of Coverage (EOC), Product Contract Documents, Member Handbooks, Schedules of Benefits (SOBs), Schedule of Benefit and Contract documents (SBC), etc., as well as ensuring compliance from a claims configuration and adjudication perspective.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Supports, develops and maintains the EOCs, SOBs, SBCs, Covered Services Lists, amendments, handbooks and all internal benefit resource documentation for all products
• Using an in-depth knowledge of Medicare, Medicaid, Commercial (HMO, PPO and POS), and other state and federal regulatory requirements, including product specific contracts, clinical operations and medical benefit requirements, this inidual will serve as the Plans product and benefit expert for the product(s) they represent
• Support all implementation steps needed to support mandated changes, internal benefit changes, new codes, and new employer-group specific benefit designs for both internal and external information
• Closely monitor state and federal legislative changes that have an impact on Plan benefits, policies and develop implementation plans for addressing such issues
• Support operational issues related to benefits, new mandates or contract changes with regulatory products
• Serve as the primary liaison between the internal product managers/external partners and the plan supporting benefit questions and adhoc inquiries and requests as they relate to contract, configuration, adjudication, and regulatory submissions
• Participate as a benefits subject matter expert (SME) on cross-functional, operational teams (Reimbursement Policy, Clinical Operations Subgroup, CCB, Claims Payment Subgroup etc.)
• Other duties as assigned

Qualifications:

Education Preferred:

• Bachelor’s Degree in Business Administration, Public Health Administration, Public Policy or a related field
  • The equivalent combination of training and experience acceptable

Experience Required:

• Minimum of 3-5 years in the Healthcare industry, particularly in positions that are familiar with product and or regulatory compliance is required
• Experience with commercial, Medicaid, and/or Medicare
  • Medicare experience preferred

Experience Preferred/Desirable:

• Experience working with Medicaid, Medicare and commercial coding rules/ regulatory requirements
• Experience working with ICD-10 and CPT coding principles
• Medical claims processing experience

Competencies, Skills, and Attributes:

• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization
• A strong working knowledge of Microsoft Office products
• Demonstrated ability to successfully plan, organize and manage projects
• Detail oriented, excellent proof reading and editing skills
• Strong analytic skills in terms of ability to interpret regulations and assess impact to products, configuration, etc.
• Ability to work independently and collaboratively, manage multiple projects and meet scheduled deadlines
• Demonstrates strong organization skills and ability to work in a rapidly changing environment
• Familiarity with government programs such as Medicare
• Claims or other experience using industry standard coding
• Experience applying analytical results to decision-making
• Must be able to understand and identify operational interdependencies between departments, particularly those leading contracts/rates, clinical coverage, benefits, and technical

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Inidual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

*WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Bilingual Referral Coordinator

Remote

Our mission is to make healthcare right. Together. We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders across the healthcare ecosystem. Together, we can improve consumer experience, optimize clinical outcomes, and reduce total cost of care.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives apply to join our team.

SCOPE OF ROLE

The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols.

ROLE RESPONSIBILITIES

• Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
• Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
• Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
• Ensures specialist notifications of referral status
• Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
• Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, status of appropriateness reviews
• Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
• Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
• Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
• Addresses referral based phone calls for Primary Care Physicians panel and completed phone messages timely
• Facilitates escalation of denied referrals to the clinical team for appeal reviews.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School Diploma
• Minimum 2 years of experience in medical management.
• Capacity to interpret health plan benefit decisions

LICENSURES AND CERTIFICATIONS

• Certification as a Medical Assistant preferred

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Some travel may be required.

As an Equal Opportunity Employer, we welcome and employ a erse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Manager, Nurse Advocates

REMOTE

CANDIDATE EXPERIENCE

FULL-TIME (REMOTE)

REMOTE

What is Trusted Health?

Trusted, Inc. is the leading digital labor marketplace and workforce management solution for the healthcare industry. We are headquartered in San Francisco but we’ve taken a digital-first approach to building our workforce and the majority of our team resides across the US and abroad.

Trusted was founded in 2017 with a focus on the largest profession in healthcare: nursing. Since then, we’ve taken a process dominated by recruiters and phone calls and converted it to a fully digital experience, connecting nurses directly to job opportunities and handling benefits, payroll, onboarding, and compliance. Our platform provides full employer of record services for employers in all 50 states and the District of Columbia.

In 2020, we launched our proprietary staffing platform, Works. Works helps hospitals solve one of their biggest challenges: filling every shift in an environment where demand for healthcare services and labor costs are increasing exponentially. With Works, facilities can create their own on-demand nursing workforce and manage all the details from a single system. Using predictive insights and recommendations, Works helps hospitals react to fluctuations in demand, while its staffing marketplace creates competition to fill open job requisitions with high-quality, active talent.

Trusted has support from top institutional investors such as Craft Ventures, Felicis Ventures, StepStone Group, and Founder Collective, as well as healthcare innovators like Texas Medical Center, Mercy Health, Intermountain Ventures, Town Hall Ventures, and Healthbox. Most recently we closed a $149 million Series C round to fund our next stage of growth.

What we’re looking for

The Manager, Nurse Advocates will lead a team of Nurse Advocates by empowering them to utilize their clinical background and expertise to foster relationships with clinicians, and ultimately place clinicians in jobs they love and build the lives they want. They will also build relationships with key stakeholders and cross functional partners, to successfully collaborate in removing barriers for the team as well as improve processes and workflows so that the team is successful in placing candidates in jobs.

Your responsibilities

• • Manage a team of customer facing nursing professionals (Nurse Advocates) in a role that supports clinicians through their Trusted job search and working phases by building rapport, engagement, and supplementing the Trusted platform through human relationship.
  • Hire, train, coach and develop the team of Nurse Advocates in customer success and sales, leveraging their strengths to create an environment of autonomy and professional growth
  • Collaborate cross functionally to be the voice of our customer with marketing, product, and operations teams, in order to drive better user experience for our clinicians.

Who you are

• • Resilient. You coach yourself and others through change as we scale by normalizing the challenges of growth, sharing your own experiences and engaging others in adaptive thinking practices. You lead others to learn from setbacks and recover swiftly. You are a role model for dealing with hardships, and you build a team culture that can face adversity with strength.
  • Customer Focused. You are a champion for the needs of the clinician. You have a deep understanding of who our customer is, what they need, and how we can serve them. You lead your team to build and cultivate new relationships, while strengthening existing ones. You are able to speak on behalf of the clinician in every cross-functional partnership, keeping the clinician’s viewpoint in mind for all solutions.
  • Courageous. You take control in high stakes situations and are able to lead your team through times of uncertainty. You make tough or unpopular decisions when needed. You communicate difficult topics with your team, holding them accountable for what is in their control. You foster an environment where people are encouraged to grow, take risks, and develop into effective and efficient Nurse Advocates.
  • Effective Communicator. You create a venue and set high standards for transparent and constructive dialogue within your team and across the organization. You discuss issues in a direct, thoughtful and forthright manner that builds trust, understanding and commitment. You are able to adapt your communication style in order to effectively work with non-clinicians within Trusted.

You have

• Preferred
  • 4+ years of leadership experience people-managing, coaching, and up-leveling a high performing team
  • 4+ years of professional experience, ideally in a healthtech or high growth, customer focused start up
  • RN required
  • BSN/MSN, MHA, MBA preferred
  • Project, process, and/or operations management
  • Customer/patient relations and incident or conflict management
  • Experience with databases and enterprise tools such as Salesforce, Asana, Front, Slack, and/or GSuite.

We offer

• • Paid vacation & sick time, paid family leave, and flexible work hours
  • Employer-paid health insurance, vision, and dental
  • Employer-paid life insurance
  • Mindfulness and fitness reimbursement
  • Monthly cell phone reimbursement
  • Employer-sponsored 401k

$108,000 – $158,000 a year

Trusted reasonably anticipates the salary range for this role to be $108k-$158k annually, plus equity. The final compensation for this position will vary based on geographic location and candidate experience relative to what Trusted reasonably anticipates for this position. We are committed to transparency, and any compensation questions will be addressed early in our recruitment process.

#LI-Remote #LI-EK1

Member Advocate

Remote 

Operations

Full-time

Remote

Our health system is broken, and it’s a huge problem. Costs are rising out of control while the patient experience gets worse. At Sana, we’re passionate about fixing this problem by bringing accessible and affordable health plans to small and medium businesses. We’ve built an innovative team with top talent from across the health insurance and tech industries to create engaging, modern plans for our clients. This allows our customers to offer competitive benefits packages while paying an average of 20% less than traditional plans.

We are looking for a hard-working, empathetic person to join our member advocacy team. We’re building a team of social workers, patient advocates, health coaches, nutritionists, and nurses to support our members in solving everyday problems.

This is a remote role and we encourage all applicants to apply, regardless of location. We are particularly looking for candidates who can work on mountain time or pacific time hours.

What you will do

• Provide accurate and easy-to-understand guidance in the complex world of health insurance and employer benefits across multiple channels (phone, text, chat, and email).
• Help new customers with their onboarding, making sure members understand and select appropriate health plans and other steps.
• Assist members with issues around their care journey – whether it’s finding a provider, helping with claims issues, or referring them to expert clinical care managers.
• Give feedback to the product team about member support issues so they can design better experiences.
• Generally strive to make sure members feel taken care of and love our service.

About you

• Bachelor’s degree with 2 years of related experience in social work, patient advocacy, or health coaching preferred.
• Comfortable with remote work.
• Excellent communicator.
• Strong preference for candidates fluent in Spanish and English.
• Some knowledge of healthcare and/or insurance benefits preferred.
• Entrepreneurial. Self-directed. Excited to build something from scratch.
• Values-oriented. You care about making our healthcare system work better for people and business owners.
• Gritty. You aren’t worried about getting your hands dirty and working hard when you need to.
• Comfortable with change. We are a startup and need people who are ok doing things outside of their traditional job description.
• Comfortable with modern web applications. We are building all of our software in-house and you will be a key constituent in its development.

Benefits

• Stock options in rapidly scaling startup
• Flexible vacation
• Medical, dental, and vision Insurance
• 401(k) and HSA plans
• Parental leave
• Remote worker stipend
• Wellness program
• Opportunity for career growth
• Dynamic start-up environment

$55,000 – $55,000 a year

Our cash compensation amount for this role is targeted at $55,000 per year for all US-based remote locations. Final offer amounts are determined by multiple factors including candidate experience and expertise and may vary from the amounts listed above.

About Sana

Sana is a modern health plan solution for small and medium businesses. We use a more efficient financing structure and integrated technology solutions to cut out wasteful spending and get members access to better quality care at lower cost. Founded in 2017, we are an experienced team of engineers, designers and health system operators. We have the financial backing of Silicon Valley venture firms and innovative reinsurance partners. If you are excited about building something new and being a part of fixing our broken healthcare system from the inside, please reach out!

Payment Integrity Medical Coder

locations

Remote

time type

Full time

job requisition id

J229270

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for educating providers on proper billing behavior and proper usage of procedure codes and/or modifiers who are identified as outliers in regards to billing Highmark for certain targeted codes; outreach may occur in various formats including written letters, emails, and consultations via telephone. Documents explanations from Provider Outliers to be used in the analysis of billing behavior and cost savings.

ESSENTIAL RESPONSIBILITIES

• Performs outreach via telephone or other means to identified Outlier Providers informing them of their inclusion as an Outlier; meaningfully discusses the Outlier Providers’ billing practices and provides education on proper usage of procedure codes and/or modifiers. May also field incoming calls from providers.
• Applies medical coding knowledge to determine applicable education for Outlier Provider’s on industry standards and guidelines as well as Payer Reimbursement Policies to enhance and ensure compliance with industry standards.
• Documents communications and explanations from Outlier Providers regarding why billing behavior is outside of the norm.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 3 years of medical coding experience
• 1 year of experience with commercial claims
• 3 years of experience with the Common Procedure Coding System (HCPCS)
• 3 years of experience with International Classification of Diseases (ICD-10) coding

Preferred

• None

SKILLS

• Knowledge of the Common Procedure Coding System (HCPCS)
• Knowledge of International Classification of Diseases (ICD-10) coding
• Understands and applies appropriate Centers for Medicare and Medicaid (CMS) guidelines to coding
• Knowledge of anatomy, physiology and medical terminology
• Excellent verbal and written communication skills
• Data Entry

EDUCATION

Required

• High school/Ged

Preferred

• Associates degree in health care or related field
• Bachelors degree in health care or related field

LICENSES or CERTIFICATIONS

Required

• Certified Professional Coder (CPC)

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% – 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$17.93

Pay Range Maximum:

$32.26

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified iniduals based on their status as protected veterans or iniduals with disabilities, and prohibit discrimination against all iniduals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment iniduals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf)

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

Inpatient Coder

Location Chicago, Illinois, USA

76960 USD – 83200 USD/Year

This is a 100% REMOTE position for Inpatient Coders in the US.

Description

• The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting, and Coding Clinics. The Inpatient Coder II has a deep understanding of disease processes, anatomy/physiology, pharmacology, and medical terminology.
• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically see average CMI’s of 2.2609. This index score demonstrates higher patient complexity and acuity.
• Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.
• Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation
• Improvement (CDI) Department who concurrently reviewed the record and provided their clinical insight on the diagnoses.
• Utilizes resources within CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Reviews Discharge Planning and nursing documentation to validate and correct when necessary, the Discharge Disposition which impacts reimbursement under Medicare’s Post-Acute Transfer Policy.
• Utilizes knowledge of MS-DRGs, APR-DRGs, and AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM’s ranking in US News and World Report.
• Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics, and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to determine the Principal Diagnosis, secondary diagnoses, and procedures
• Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions, and instructional notes to assign the appropriate diagnoses and procedures.
• Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.
• Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors.
• Meets established coding productivity and quality standards.

Top Skills Details:

• Medical coding, RHIT, RHIA, CCS, Inpatient, Hospital, Academic, Trauma 1, AHIMA

Additional Skills & Qualifications:

• 3 years of inpatient coding experience in an academic facility (teaching hospital)
• RHIA, RHIT or CCS credential
• AHIMA membership

Nurse Practitioner (Remote – Telemedicine)

at Found

Remote

Found is a modern weight care platform and community focused on integrated support. According to a recent CDC study, nearly 50% of Americans want to lose weight, and on average, Americans have gained 30 lbs during the pandemic. But the existing weight loss industry focuses on shame – if you don’t have the willpower to eat less and workout more, you aren’t trying hard enough.

Modern science shows us that weight care is complex – food and movement are important, but so are hormones, genetics, sleep, stress, mental health, and daily habits. Found’s unique approach incorporates resources and tools for behavior changes, a digital app with guided programming, an online community, and if indicated, medical and prescription solutions.

Research shows that addressing weight health reduces the long-term risk of diabetes, heart disease, and some forms of cancer. We believe in giving our community tools that will help them add years to their lives and reach their goals. We believe it’s not just what you’ve lost, it’s what you’ve Found. Found has raised more than $130mm from leading investors, including Atomic, GV, WestCap, IVP, TCG, Define Ventures and more.

Why Clinicians Love Found:

• Meaningful work in leading obesity care practice, one of the largest in the US
• Flexible work schedule
• Custom built, easy to use EMR that allows you to focus on delivering patient care

What You’ll Do:

• Conduct asynchronous consultations with patients, including health assessment, lab screening, diagnoses related to obesity, prescribing medication & follow-up care for patients as indicated
• Educate patients on appropriate treatments and care plans for their health history, weight loss objectives, and access to medication
• Provide ongoing clinical support to patients as they navigate their weight care journey (managing medication side effects, change treatment plan based on changes in patient’s health, weight loss progress, &/or insurance coverage)
• Provide compassionate and meaningful care employing shared decision making with your patients
• Complete required onboarding training, engage in quality assurance processes, and adhere to company guidelines and policies

What You’ll Bring:

• Passion for working in a rapidly growing business with curiosity, humility, humor, and professionalism
• Must have 2+ years experience in hospital/clinic setting, with at least one of those in an obesity care setting
• Ideally will have a certification with the Obesity Medicine Association
• At least one year of working in a telehealth setting
• Excellent written and verbal communication with an emphasis on clarity and compassion
• The ability to pick up new technologies quickly, you are proactive, organized, & detail-oriented.
• A clean malpractice history
• Multiple state licenses required, preference for at least one license in CA or TX

Title: Full Time Bilingual New York (NY) Licensed Nurse Practitioner (NP) – (English/Spanish) (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a Series B startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A person who’s passionate about working closely with a clinical team to ensure the best clinical outcomes for those we serve. A person who enjoys a fast paced clinical environment, performing telephonic and virtual visits related to proactive chronic care management, remote patient monitoring, and/or resolving more urgent clinical issues quickly. Lastly, someone who aspires to work with a company who is on the leading edge of community health working with partners to allow our elderly to remain at home and free of avoidable hospitalizations.

The ideal teammate would be able to:

• Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
• Conduct care coordination and recommend/identify cost effective research based treatment and intervention
• Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
• Be comfortable with advanced care planning discussions with caregivers and members
• Serve as a consulting resource on care management practice as needed
• Attend meetings, training sessions and participates on committees as needed
• Possess a strong knowledge of clinical procedures, standards and quality control checks
• Possess a strong knowledge of medical conditions, interventions and treatment
• Provide members, caregivers and facility education
• Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

• Certified and licensed as a Nurse Practitioner in good standing in the state of New York (required)
• Ability to read, write and fluently speak Spanish AND English (required)
• Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
• Medicare participation and ability to have the company bill for services on your behalf (required)
• Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
• 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
• 1+ years of telephonic triage or equivalent experience (required)
• 2+ years of clinical experience working with complex adult populations (required)
• Ability to practice independently with little clinical support (required)
• Comfort using technology like Google Suite, multiple EMRs, Slack (required)
• Experience working in home care and/or family medicine, geriatrics (preferred)
• Experience working within a clinical team environment
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• Strong organizational skills, including the ability to prioritize
• Passionate about our mission to improve people’s lives
• Comfortable in a dynamic and always evolving startup environment

If yes, then we look forward to speaking to you!

The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.

This role will be paying up to $125,000 depending on experience.

Inpatient Medical Coding Supervisor – Hospital

locations

US – Remote (Any location)

time type

Full time

job requisition id

10747

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Need:

The Inpatient Medical Coding Supervisor- Hospital supervises the coding unit including inpatient coders, inpatient denials and inpatient coding auditors. Prioritizes and coordinates work to meet delivery standards.

• Identifies productivity and quality standards for coders. Monitors performance against standards monthly and provide feedback to the staff on their results. Quality reviews will include ICD-10CM, ICD-10PCS, DRG accuracy and completeness. Ensures that staff is reaching productivity and quality targets.
• Develops and maintains hospital and department specific coding guidelines, training manuals, policies and procedures. Upon completion submits to Director of HIM Facility Coding for approval.
• Oversees staffing including preparing weekly, holiday, PTO, and vacation schedules, including completing payroll approvals. Tracking staffing levels, e-learning and annual health assessments. Interview prospective staff. Completes at least monthly staff meetings providing formal monthly communication. Evaluates employees annually completing by March of the following year.
• Provides support, training and education for staff including orientation to new staff. Continue to develop knowledge, talents and skills of staff.
• Serves as a resource to customers including HIM and other departments, UHS system members and assist with HIM coding issues. Continuously seeking innovative ways to improve.
• Codes charts and review for clinical documentation to maintain skills and relationship with staff.
• Serves as a resource to UHS system members and facility staff on coding issues.
• Participates in all section, department and committee meetings as appropriate.
• Monitosr reports of records un-billed for 3M over 5 days, coding hold list, and denials and audits results lists and allocates resources to ensure timely completion of discharged records.
• Assists physicians or other providers with questions when code assignments are not straight forward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Providing information/education as needed.
• Coordinates and facilitates external coding compliance, reviews/audits as needed.
• Understands 3M integration with Soarian, Document Imaging, and SMART. Coordinates changes with those necessary to ensure smooth implementation of changes. Monitors 3M integration and Epic work queues.
• Reviews the current OIG work plan for DRG risk areas in the HIM department. Review these charts to identify patterns, trends, and variation in these cases. Once identified, evaluate the causes of change or problems and takes appropriate action to resolve or explain variances.
• Maintains credentials and appropriate CEU’s.

What You Will Need

• RHIT, RHIA, CCS, CPC, or CIC certification
• Three (3) to five (5) years of experience in coding
• Working knowledge of MS- DRG’s, APR’s, hospital coding and electronic medical record
• Experience with electronic medical records.

What Would Be Nice To Have:

• RHIA
• Three to Five (5) years of supervisory experience.
• Experience with regulatory agencies and third party payers.
• Associate’s Degree or Bachelor’s Degree in HIT.

#Indeedsponsored

#LI-Remote

The annual salary range for this position is $78,900.00-$138,200.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a erse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Provider Enrollment Specialist

at Grow Therapy

Remote

About us:

We’re on a mission to fundamentally transform mental healthcare accessibility. Grow Therapy empowers therapists to launch and grow thriving insurance-accepting private practices. We’re creating game-changing technology to build America’s biggest behavioral healthcare group and ensure that anyone can afford quality mental healthcare. Following the mass increase in depression and anxiety, the need for accessibility is more important than ever.

To make our vision for mental healthcare a reality, we’re building a team of entrepreneurs and mission-driven go-getters. Our founders come from Harvard Medical School, Stripe, and Blackstone, and are champions of balancing bold ambitions with a culture that promotes holistic well-being. Since launching in 2020, Grow has raised over $90M from top VCs and angel investors, including TCV, Transformation Capital, SignalFire, Village Global, CoFound, and leaders of Oscar, Nurx, Quartet, Airbnb, and Blackstone.

What You’ll Be Doing:

We’re looking for an experienced Provider Enrollment Specialist who is passionate about improving the landscape for mental healthcare. In this role, you’ll own the credentialing processes for 5-10 of our payors, so you’ll play a key role in getting our providers in-network with some of the country’s largest health plans. Responsibilities include:

• Ensuring our providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for 5-10 of our payors.
  • Monitor our submission processes to make sure that all applications are submitted within SLA. Understand our submission protocols and update them as needed.
  • Monitor the follow up process applications, and communicate with the payors directly to ensure that applications are staying on-track.
  • Conduct regular reviews to validate the accuracy of our internal credentialing data against the payor’s data to ensure our credentialing data serves as a source of truth across the organization.
  • Maintain documentation for each process to ensure smooth operations.
  • Work with the Revenue Cycle Management team on any Credentialing related claim denials.
• Assist in building out new payor operations as we onboard new payors.
  • Create the Submission Protocol for new payors so that applications can be submitted in a standardized format.
  • Work with the payor to understand the best way to follow up on applications, and document the process accordingly.
  • Determine the best way to regularly review the accuracy of internal credentialing data whether it be requesting a report from the payor or checking a portal.
• Provide a synthesis of each payor’s credentialing operations to the Senior Manager, Credentialing Operations on a biweekly basis based off the data you’re monitoring in our credentialing system

Salary range: $52,625 – $75,750

You’ll Be a Good Fit If:

• You’re a behavioral health credentialing expert. You’ve communicated with payors directly in the past, and you meet the following requirements:
  • Certified Provider Credentialing Specialist (CPCS) with at least two years of experience in Provider Credentialing OR at least four years of experience in Provider Credentialing
  • Strong familiarity with credentialing processes, terminology and primary source verification resources; these include: CAQH, NPDB, PECOS, State Licensing, Accreditation and Certification agencies
• You’re great at problem perception and escalating when you need help. You know when you need to loop someone in because you’re not getting what you need or something seems off.
• You have excellent communication skills. You have the ability to be persuasive and credible with a wide variety of audiences both internal and external.
• You know how to hold people accountable. You drive clarity on what’s needed to get something done, and you ensure deadlines are met.
• You’re tech savvy. You’ve efficiently learned new software in the past, and you’re willing to learn HubSpot, Verifiable, Slack, and Excel if you don’t know how to use them already.
• You’re comfortable with a face-paced, high growth environment.

If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.

Benefits

• The chance to drive impact within the mental healthcare landscape from day one
• Comprehensive health insurance plans, including dental and vision
• Our dedication to mental health guides our culture. Wellness benefits include (but are not limited to):
  • Flexible working hours and location (remote OR in-office, your choice!)
  • Generous PTO
  • Company-wide winter break
  • Mental health mornings (2 hours each week)
  • Team meditation
  • Wellness Stipend
  • In-office lunch and biweekly remote lunch on us!
• Continuous learning opportunities
• Competitive salary
• The opportunity to help build a rapidly scaling start-up organization by taking strong ownership of your work, mentorship, and our unbounded leadership opportunities

#LI-REMOTE

Patient Registration and Scheduling Representative

Job Location Other-Remote Office

ID 2023-10523

Status Full Time

Shift Varied

Schedule Varied

Hours of Work Varied throughout the week and every other weekend 10hr days

Responsibilities

The Patient Registration and Scheduling Representative will ensure registration, pre-registration, and scheduling of various patient types, including: residential assessments, admissions and outpatient appointments (Substance Use and Mental Health). Documentation of registration and scheduling is required to be efficiently and accurately completed within the EHR system prior to the patient admission.

• Completes the Registration and Pre-Registration process for patients.
• Schedules appointments for services within residential and outpatient settings.
• Actively participates in creating and implementing improvements to achieve patient satisfaction, efficiency outcomes, and to optimize revenue cycle.

This position is fully remote.

Qualifications

Required Qualifications:

• High School Degree or equivalent
• 2 or more years working in customer service in a healthcare setting, working with insurance, registration, coding medical records and/or related office experience. working directly with a patient population regarding insurance and finances
• Must have ability to multi-task between several computer systems
• Knowledge of basic Microsoft office programs and 10-key skills, including data entry
• Able to develop effective rapport with customers, co-workers, or families, actively listening to develop a positive connection

Preferred Qualifications:

• Associates or Bachelor’s Degree
• Knowledge specifics of multiple health insurance plans per patient accounting department guidelines based on payer requirements.

Min USD $18.73/Hr.

Max USD $26.44/Hr.

Overview

The Hazelden Betty Ford Foundation is the largest nonprofit addiction recovery organization in the United States. It is also one of the most mission-driven places you will find. The Hazelden Betty Ford Foundation team is passionate about providing hope and ultimately healing. As a living, growing and evolving institution, the Hazelden Betty Ford Foundation is – at our core- a people-powered organization. Hazelden Betty Ford Foundation is comprised of 1600+ employees, seventeen treatment sites and produces $190 million dollars in annual revenue. This exemplary organization serves nearly 25,000 people annually and is committed to provide hope and healing for those experiencing addiction to alcohol and other drugs.

What makes this organization unique is its total ecosystem approach to prevention, education, research, advocacy and treatment. All of the parts of the organization work together to inform, develop and deliver evidence- based practices that help people reclaim their futures and restore their hope.

Being “a best place to work” is a strategic goal of Hazelden Betty Ford Foundation and it’s a goal that every employee plays an active role in helping to achieve. Our culture is a reflection of how encouraged and energized we each feel about contributing our ideas and performing to our greatest ability. Join us and do meaningful work.

We deeply value our employees. Working at Hazelden Betty Ford Foundation includes a comprehensive benefits package, including:

• Competitive Health, Dental and Vision Plans
• Retirement savings plan with employer match
• Paid time-off
• Tuition reimbursement

The Hazelden Betty Ford Foundation is proud to be an equal opportunity and affirmative action employer. We believe that ersity and inclusion among our colleagues is critical to our success as a force of healing and hope for iniduals, families and communities affected by addiction to alcohol and other drugs; and we seek to recruit, develop and retain the most talented people from a erse candidate pool.

Billing Success Associate

Remote 

Provider Network Ops Billing Operations

Full-time

Remote

About Lyra Health

Lyra is transforming mental health care through technology with a human touch to help people feel emotionally healthy at work and at home. We work with industry leaders, such as Morgan Stanley, Uber, Amgen, and other Fortune 500 companies, to improve access to effective, high-quality mental health care for their employees and their families. With our innovative digital care platform and global provider network, 10 million people can receive the best care and feel better, faster. Founded by David Ebersman, former CFO of Facebook and Genentech, Lyra has raised more than $900 million.

About the Role

Lyra Health is looking for a detail-oriented and highly motivated inidual to join our team as a Billing Success Associate. This person will share responsibility with the team for responding to queries from Lyra clients and providing general support with billing questions, coordinating with the provider support team, and helping to troubleshoot issues. We are looking for someone with a collaborative nature who is able to work independently with a sense of urgency to manage day to day tasks.

Responsibilities:

• Work directly with clients to resolve billing concerns & troubleshoot client cases
• Collaborate with internal billing teams and customer success to resolve client cases
• Troubleshoot issues related to client accounts and collaborate with provider team to complete steps necessary to use health plan benefits
• Collaborate with technical teams to identify bugs and improve the client/provider experience
• Monitor Salesforce billing queue & meet daily productivity goals
• Take troubleshooting calls and zoom meetings, as needed

Qualifications:

• 1+ years experience in healthcare billing and/or customer service
• Experience in healthcare and/or medical billing a plus
• Experience with Zendesk, Salesforce, and/or JIRA a plus
• Excellent attention to detail
• Planning, problem-solving and critical thinking skills to anticipate, avert, or resolve issues in staffing, scheduling and task allocation.
• Excellent communication skills-both verbal and written, with an emphasis on rapport building
• Passionate about improving mental health care and excited by our mission of leveraging technology to scale access to evidence-based therapies.
• Ability to innovate and creatively solve problems in a highly collaborative manner
• Ability to flourish in a fast-paced, rapidly changing environment
• Prior experience working in a technology environment a plus

$61,000 – $93,000 a year

As a full-time Billing Success Associate, you will be employed by Lyra Health, Inc. The anticipated annual base salary range for this full-time position is $61,000-93,000. The base range is determined by role and level, and placement within the range will depend on a number of job-related factors, including but not limited to your skills, qualifications, experience and location.

At Lyra, base salary is only one aspect of an employee’s total compensation package, which additionally may include discretionary restricted stock unit awards, comprehensive medical and dental coverage, and retirement benefits. This role may also be eligible for discretionary bonuses.

This role is a remote opportunity. Qualified candidates located outside of California are welcome to apply! Candidates who include a cover letter will be prioritized.

We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability, genetic information or any other category protected by law.

Title: NOC Specialist Tech Support

Location: Remote

Company Description

Amwell is a leading telehealth platform in the United States and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell believes that digital care delivery will transform healthcare. We offer a single, comprehensive platform to support all telehealth needs from urgent to acute and post-acute care, as well as chronic care management and healthy living. With over a decade of experience, Amwell powers telehealth solutions for over 150 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, covering over 80 million lives.

Brief Overview:

As a Network Operations Center Specialist within the Technical Support Team, you will play a key role in the day to day operations of the Online Care Group, including 24/7/365 physician support, escalation resolution, and real-time monitoring of volume utilizing workforce management tools. We are looking for full time employees who have flexible schedules and can work either overnight, evening or weekend hours.

Core Responsibilities:

• Act as the first line of defense for all provider troubleshooting escalations
• Conduct remote desktop support sessions to troubleshoot, identify and find a solution to provider reported technical issues
• Lead investigation into system communication failures
• Maintain queue of open tickets and work cross-functionally to drive resolution
• Conduct video check-in visits with all newly credentialed Online Care Group providers and introduce them to NOC Support
• Work with Manager and Team Leads to stay current on all changes in the American Well core product
• Conduct usability testing on new builds of the Provider Mobile App
• Conduct validation testing in all new builds to verify features are working as expected
• Escalate and track any new defects and work with management to drive resolution
• Acts as the main point of contact for all provider-related support questions and issues via phone, email and live chat
• Uses critical thinking skills to prioritize and problem solve provider requests
• Uses trackers to appropriately log notable events that occur throughout shift
• Act as main point of contact for internal teams to discuss and drive resolution for outstanding items
• Upholds tracking of all support escalations utilizing Salesforce tools

Qualifications:

• Robust interpersonal and communications ability, including strong written and verbal communication skills
• Adaptability in a fast-paced start up environment
• Fast learner, ready to jump right in with little direction
• Ability to effectively communicate via phone, video-conference, and written communication
• Ability to multitask and quickly change gears as directed by Team Leads and Managers
• Proficient in all basic computer functions and programs, including Microsoft Office Suite
• Strong customer service orientation and the ability to interact with erse groups
• Experience resolving issues live on the phone in a call center environment; ability to maintain control of a phone call in tough situations
• Experience successfully troubleshooting various types of end-user issues by way of desktop support software/desktop sharing
• Experience with Salesforce or other CRM preferred
• Education Associate Degree or Bachelor Degree preferred Experience 1-2 years related experience preferred

Additional information

Working at Amwell:

Amwell is changing how care is delivered through online and mobile technology. We strive to make the hard work of healthcare look easy. In order to make this a reality, we look for people with a fast-paced, mission-driven mentality. We’re a culture that prides itself on quality, efficiency, smarts, initiative, creative thinking, and a strong work ethic.

Our Core Values include One Team, Customer First, and Deliver Awesome. Customer First and Deliver Awesome are all about our product and services and how we strive to serve. As part of One Team, we operate the Amwell Cares program, which brings needed assistance to our communities, whether that be free healthcare for the underserved or for people affected by natural disasters, support for equality, honoring doctors and nurses, or annual Amwell-matched donations to food banks. Amwell aims to be a force for good for our employees, our clients, and our communities.

Amwell cares deeply about and supports Diversity, Equity and Inclusion. These initiatives are highlighted and reflected within our Three DE&I Pillars – our Workplace, our Workforce and our Community.

Amwell is a “virtual first” workplace, which means you can work from anywhere, coming together physically for ideation, collaboration and client meetings. We enable our employees with the tools, resources and opportunities to do their jobs effectively wherever they are!

The typical hourly wage range for this position is $16.81 – $23.11. The actual hourly wage offer will ultimately depend on multiple factors including, but not limited to, knowledge, skills, relevant education, experience, complexity or specialization of talent, and other objective factors. This role may also be eligible for an annual bonus based on a combination of company performance and employee performance. Long-term incentive and short-term variable compensation may be offered as part of the compensation package dependent on the role.

Further, the above range is subject to change based on market demands and operational needs and does not constitute a promise of a particular wage or a guarantee of employment. Your recruiter can share more during the hiring process about the specific wage range based on the above factors listed.

Additional Benefits

• Flexible Personal Time Off (Vacation time)
• 401K match
• Competitive healthcare, dental and vision insurance plans
• Paid Parental Leave (Maternity and Paternity leave)
• Employee Stock Purchase Program
• Free access to Amwell’s Telehealth Services, SilverCloud and The Clinic by Cleveland Clinic’s second opinion program
• Free Subscription to the Calm App
• Tuition Assistance Program
• Pet Insurance

Professional Fee Coder III (Fully Remote)

Apply

locations

Remote Location

time type

Full time

posted on

Posted 7 Days Ago

job requisition id

223591

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Professional Fee Coder III (Fully Remote)

Location

Cleveland

Facility

Remote Location

Department

Coding ReimbursementChief Of Staff Division

Job Code

U99930

Shift

Days

Schedule

8:00am4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patientfirst healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

This position will be supporting our Anesthesia Coding Team. As a Professional Fee Coder III, your primary duties include, but are not limited to:

• Monitoring, reviewing, and applying correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research and compliance.
• Identifying and applying diagnosis codes, cot codes, and modifiers as appropriately supported by the medical record in accordance with federal guidelines.
• Ensuring that billing discrepancies are held and corrected.

The ideal ,caregiver is someone who:

• Is familiar with the 2021 coding guideline changes.
• Has at least 3 years of coding experience.
• Is familiar with ICD 10 DX coding, E/M Leveling, and Specialty Coding.
• Is technologically proficient.
• Demonstrates a strong work ethic.

This is an excellent opportunity for someone who seeks to enhance their coding skills while working remotely.

At Cleveland Clinic, we know what matters most. That is why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you will find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental wellbeing, and your future. When you join Cleveland Clinic, you will be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare roles.

Job Details

Responsibilities:

• Compares and reconciles daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges, manual data entry.
• Maintains records to be used for reconciliation and charge follow up.
• Investigates and resolves charge errors.
• Meets coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
• Responsible for working professional held claims in CCF claims processing system.
• Reviews, abstracts and processes services from surgical operative report.
• Reviews, communicates and processes physician attestation forms.
• Communicates with physician and other CCF departments (cosurgery) to resolve documentation discrepancies.
• Assists with Evaluation and Management (E&M) audits and other reimbursement reviews.
• Responsible for working E&M denials on the denial database.
• Other duties as assigned.

Education:

• High School Diploma / GED or equivalent required.
• Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college.
• Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

Certifications:

• Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCSP), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) or Certified Outpatient Coder (COC) by American Academy of Professional Coders is required and must be maintained.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking and analytical skills, decisive judgment and work with minimal supervision.
• Requires excellent communication skills to be able to converse with the clinical staff.
• Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

Work Experience:

• Minimum of 3 years coding to include 1 year of complex coding experience in a health care environment and or medical office setting required.
• Must demonstrate and maintain accuracy and proficiency in coding and claims editing to be considered for a Professional Coder III position.
• Candidate must currently be employed as a Professional Coder II at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of a Professional Coder II.

Physical Requirements:

• Typical physical demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard.
• Manual dexterity required to locate and lift medical charts.
• Ability to work under stress and to meet imposed deadlines.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

Keywords: HIM, Health Information, Health Information Management Coder, Medical Coder, Coding Clinical Coder, ICD10, ICD9, RHIA, RHIT, CCS, CCSP, CPC, CCA

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after 90 days.

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID19, or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Please review the Equal Employment Opportunity poster.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Iniduals with Disabilities

Hospital Inpatient Coder

Location: Denver, CO, United States

Category: Administrative/Clerical Support Job Type: Full Time

Remote Hospital Inpatient Coder

This is a full-time, remote/work from home, hourly position on the UCHealth Inpatient Coding team. Potential opportunity for eligible out-of-state applicants. Flexible work schedule. All required hardware/software provided, including dual monitors, keyboard, mouse. Assigns ICD-10-CM and PCS codes using computer-assisted-coding tools, and applies appropriate coding classifications for assigned service lines.

Job duties

• Responsible for accurately assigning and sequencing ICD-10 CM and PCS codes and POA indicators, identifying query opportunities, and abstracting data based on medical record documentation for all acute care hospital patient types.
• Appropriately applies official coding guidelines and relevant coding references to all inpatient coding scenarios.
• Collaborates with CDI, Quality, and leadership to capture necessary quality measures.
• Enhances coding knowledge and skills with continuing education.

Requirements

• High School diploma or GED
• Coding-related certification from AHIMA or AAPC
• 1 year of Inpatient coding experience OR 3 years of Outpatient coding

Preferred

• Certified Coding Specialist (CCS) highly desired
• 3+ years of hospital inpatient coding experience highly desired
• Level I Trauma coding experience
• Epic experience
• 3M encoder experience
• Computer-assisted coding

The pay range for this position is: $24.11 – $36.17 / hour. Pay is dependent on applicant’s relevant experience.

UCHealth offers a Five Year Incentive Bonus to recognize employee’s contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years’ employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:

• Full medical, dental and vision coverage
• Retirement plans to include pension plan and 403(b) matching
• Paid time off. Start your employment at UCHealth with PTO in your bank
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition and continuing education reimbursement
• Wellness benefits
• 5-year incentive bonus
• Full suite of voluntary benefits such as identity theft protection and pet insurance
• Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year
• Loan Repayment: UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

Billing Specialist

US – Remote

Who we are

Healthcare is more confusing, more costly, and more complex than ever. Transcarent is a health and care experience company on a mission to empower Members to stay healthy by providing them with unbiased information, trusted guidance, and easy access to high value care where and when they need it. You will be part of a world-class team, supported by top tier investors like 7wireVentures and General Catalyst, and founded by amission-driven teamcommitted to transforming the health and care experience for all. We closed on our Series C funding in January 2022, raising our total funding to $298 million and enabling us to respond to the demand for rapid expansion of our offering.

Transcarent is committed to growing and empowering a erse and inclusive community within our company. We believe that a team with erse lived experiences, working together will strengthen our organization, and our ability to deliver “not just better but different” experiences for our members.

We are looking for teammates to join us in building our company, culture, and Member experience who:

• Put people first, and make decisions with the Member’s best interests in mind
• Are active learners, constantly looking to improve and grow
• Are driven by our mission to measurably improve health and care each day
• Bring the energy needed to transform health and care, and move and adapt rapidly
• Are laser focused on delivering results for Members, and proactively problem solving to get there

What we look for in this role

Our Billing Team is growing and seeking an energetic self-starter who shares our passion for providing excellent customer service. Billing Specialists are responsible for delivering quality billing services to our clients, providers, and Members, with a strong focus on timeliness, accuracy, and efficiency. The ideal candidate has outstanding organizational skills and excels in a deliverable-focused, fast-paced environment.

What you’ll do for our team

• Own the end-to-end billing process for our SurgeryCare product; from initial invoicing through claims collection/review and reconciliation.
• Independently manage case workload and complete deliverables timely, accurately, and in an organized fashion.
• Serve as the primary billing contact for an assigned group of clients and create an excellent client experience by addressing, escalating, and resolving billing and payment issues in a timely and appropriate manner.
• Post invoices, payments, and other transactions to General Ledger (NetSuite) and assist Corporate Accounting Team as needed.
• Be a resource to Billing Team Management by finding and implementing solutions to benefit team, improve processes, and create efficiencies.
• Collaborate and problem-solve with other internal teams such as Care Coordination, Provider Relations, and Client Success.

What we’re looking for

• Associate’s Degree or equivalent experience
• 1-2 years of customer service experience
• Computer skills required, including proficiency with Microsoft Office applications
• Comfortable working independently and as part of a team, with minimal direct supervision
• Highly organized and detail-oriented; follows processes and procedures, but conscientious about continuously improving and creating more efficient and effective methods
• Excellent interpersonal and communication skills; willingness to speak up, ask questions, or request clarity when something is unclear
• Ability to shift focus when priorities change without losing sight of original tasks and deadlines
• Experience working and collaborating in a remote environment, mindful of information privacy (HIPAA)
• Available and flexible to work additional hours, as business needs require

Nice to have skills:

• Medical Coding experience
• Healthcare industry, medical billing, or revenue cycle experience
• Familiarity with Salesforce, Jira, and/or NetSuite.
• Knowledge of claims and coding types, such as UB-04, CMS-1500, HCPCS, ICD-9, and ICD-10
• Experience with accounting operations Accounts Receivable, Accounts Payable, etc.
• Although we are fully remote at this time, we would like to hire this person in a geographic area/time zone near other teammates (Bay Area-CA, Denver-CO, Chicago-IL).

Inidual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity.

Salary is just one component of Transcarent’s total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

Our benefits and perks programs include, but are not limited to:

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 12 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Location

You must be authorized to work in the United States. Depending on the position we may have a preference to a specific location, but are generally open to remote work anywhere in the US.

Transcarent is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!

Research shows that candidates from underrepresented backgrounds often don’t apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we aren’t looking for someone who checks each box on a page; we’re looking for active learners and people who care about disrupting the current health and care with their unique experiences.

Head of Clinical Operations

REMOTE (US) 

CLINICAL

FULL-TIME

REMOTE

About us:

We are the world’s largest telenutrition and foodcare solution, backed by a national network of Registered Dietitians and designed to yield consistently healthier food choices, lasting behavior change and long-term results. Foodsmart’s highly personalized, digital platform guides members through a personalized journey to eating well while saving them time and money. Foodsmart seamlessly integrates dietary assessments and nutrition counseling with online food ordering and cost-effective meal planning for the whole family that makes the most of ingredients at home and on the go. With national and regional retail partners across the US now accepting SNAP/EBT, Foodsmart helps bring healthier food within reach to eligible members and can also assist with SNAP enrollment.

Founded in 2010 by CEO Jason Langheier, MD, MPH, Foodsmart has supported over 1.5 million members from over 700 health plan, employer and health system clients, and raised over $70 million in funding from leading strategic and venture investors like Advocate Aurora Health, Blue Cross Blue Shield Massachusetts, Seventure (Natixis), Mayfield and Founder Collective.

About the role:

Foodsmart is seeking a highly skilled, challenge-driven, and motivated Head of Clinical Operations to lead our provider network. The Head of Clinical Operations will be accountable for the delivery of high quality care, maximizing patient retention and engagement, and exceeding Foodsmart’s patient growth targets, clinical outcomes, and revenue goals. This inidual will collaborate with various teams to enhance adherence to clinical programs, improve outcomes, and drive growth. The Head of Clinical Operations will be responsible for managing a team of high-performing managers and our expanding provider network, including both full-time and independent contractor providers.

The ideal candidate understands the healthcare industry and uses data to drive strategic decision-making. This candidate has a proven track record of executing on key financial, capacity, efficiency, quality and patient experience initiatives.

You will:

• Lead and manage the clinical provider team, nurturing a strong team culture and optimizing provider satisfaction and retention that results in positive impact on members and their health
• Define Provider Group strategy and roadmap to optimize Foodsmart’s virtual care model, drive patient outcomes, and achieve strong clinical ROI
• Collaborate with clinical operations team to engage providers in clinical programs and design new offerings to drive outcomes
• Monitor provider team schedules, utilization, and operational needs to maximize bookings
• Leverage supply/demand planning models to make sure existing clients have adequate ongoing provider capacity in a sustainable manner
• Establish and track clinical OKRs to align with business OKRs
• Develop performance dashboards to regularly monitor OKRs and iterate as necessary
• Execute against measurable financial, capacity, efficiency, quality, and patient experience goals and KPIs
• Proactively identify new opportunities to grow and expand Foodsmart’s clinical team

You are:

• Highly emotionally intelligent and self-aware; able to understand other people, what motivates them and how to work cooperatively with them
• A great people leader: effective at deploying coaching including 1:1 conversations, patient shadowing, and group trainings
• Excellent at identifying automation opportunities and implementing them fast
• Strong with leveraging data and analytics, and can build/understand models to address business challenges and drive business growth and innovation

You have:

• At least 8 years of telehealth, clinical, or marketplace operational experience
• 5+ years of managing large teams in an operational leadership role
• Experience in a high-growth startup environment, with a track record of scaling teams while maintaining clinical quality and provider satisfaction
• Experience building employee supply/demand models and utilization planning to cover demand needs
• Experience using data and analytics to inform decision making
• High level of executive presence and proven track record interacting externally with clients/partners to achieve performance objectives

About our Benefits:

• Remote-First Company
• Unlimited PTO
• Flexible & remote location (Bay Area preferred)
• Healthcare Coverage (Medical, Dental, Vision)
• 401k, bonus, & stock options
• Commuter benefit
• Gym reimbursement Role

Role: Head of Clinical Operations

Level: M5

Location: Remote

Base Salary Range: $170,000/yr to $200,000/yr + equity + bonus + benefits

Engineer II, Quality

Remote Eligible: Remote Global

Location: Marlborough, MA, US, 01752

Additional Location(s): US-MN-Arden Hills; Ireland-Galway; US-MN-Maple Grove

Diversity – Innovation – Caring – Global Collaboration – Winning Spirit – High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of erse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing whatever your ambitions.

Quality System Engineer II

About the role:

The Quality System Engineer II will serve as a Quality representative to improve awareness, visibility and communication on Global quality initiatives and objectives as well as support assigned departmental, functional, site, isional and corporate quality goals, and priorities. He/she/they will support quality initiatives ensuring compliance to medical device regulations and BSC Quality System requirements, relating to Customer Related Service sub-process, with a continuous improvement mindset.

This position is 100% remote and is open to candidates located at any Boston Scientific site.

Your responsibilities include:

• Document and communicate internal and external compliance-related information, including changes in regulations, new guidelines, and guidance documents along with other information from regulatory authorities
• Apply effective, systematic problem-solving methodologies in identifying, prioritizing, communicating, and resolving quality issues
• Assure the development and execution of streamlined business systems to effectively identify and resolve quality issues
• Document non-conformances, evaluate impact, and make recommendations for corrective actions
• Communicate non-conformances to owners, managers, directors, and upper management
• Support departmental, functional, isional, and corporate quality goals and priorities
• Support quality disciplines, decisions, and practices
• Build quality into all aspects of work by maintaining compliance to all quality requirements
• Participate in CAPA and Continuous Improvement project teams as appropriate
• Perform other duties as necessary or required by the department or organization

Required Qualifications:

• Minimum of a Bachelor’s degree
• Minimum of 2 years’ experience in medical device manufacturing, quality, regulatory/compliance, or related field
• Working knowledge of quality system requirements as stated within 21 CFR Part 820 and ISO 13485
• Proficient with Microsoft Office applications (Outlook, Excel, PowerPoint)
• Willingness to travel up 10% internationally

Preferred Qualifications:

• Working knowledge of Windchill and SAP
• Experience with Quality Systems or Country/Distribution QA or experience working in a commercial or supply chain organization
• Ability to work independently and as a member of a team in a dynamic environment with experience writing and reviewing concise technical documents
• Experience communicating, facilitating, and presenting virtually to internal and external stakeholders on complex technical topics
• Strong project management and organizational skills with attention to detail and experience working in cross-functional teams and driving projects to completion

Requisition ID: 565632

Among other requirements, Boston Scientific maintains specific drug testing requirements for safety-sensitive positions. This role is deemed safety-sensitive and, as such, candidates will be subject to a drug test as a pre-employment requirement. The goal of the drug testing is to increase workplace safety in compliance with the applicable law.

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!

At Boston Scientific, we recognize that nurturing a erse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve. Boston Scientific is proud to be an equal opportunity and affirmative action employer.

Boston Scientific maintains a drug-free workplace. Pursuant to Va. Code 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.

Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.

Risk Mitigation Coding Auditor

United States

JOB DESCRIPTION

Risk Mitigation Coding Auditor

Lead I – BPM

Who we are:

Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future—providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment, and quality and provider engagement initiatives.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.

You are:

The Risk Mitigation Coding Auditor will assist with risk mitigation and government audits. This position requires the candidate to have a proficient level of understanding of risk adjustment coding, coding guidelines, and CMS/ HHS regulatory guidance. The auditor will use their knowledge to conduct audits, on behalf of clients, to validate MA and ACA risk adjustable HCCs that were previously reported, by a provider, to ensure the support of Risk adjustable HCC diagnoses in line with CMS and client guidelines.

The Opportunity:

• Ensure compliance with all applicable federal, state, and county laws and regulations related to coding and documentation guidelines for Medicare and ACA Risk adjustment
• Conduct EDPS/RAPS submission audits by diagnosis codes submitted by CMS Acceptable Physicians Specialty types for Risk Adjustment data submission
• Validate diagnosis codes to ensure adherence with ICD-10-CM and CMS guidelines.
• Perform Government audits on MA and ACA lines of business
• Perform medical record audits on behalf of health plans, to ensure documentation supports submitted CMS and HHS Hierarchical Condition Categories (HCC) conditions for the Commercial and Medicare Risk Adjustment Payment system.
• Perform medical record reviews to capture all relevant diagnosis codes included in the CMS and HHS hierarchical condition categories (HCC), focusing to close gaps and add HCC codes not yet reported for the payment year.
• Keep current on Medicare and HHS risk adjustment models and maintain up-to-date coding knowledge by reviewing materials, and attending departmental meetings and educational events, either disseminated and/or recommended by clients and managers.
• Contribute to the quality improvement activities of the department and the organization
• Make corrections (additions and deletions) as needed to ensure accurate submission of HCC codes to CMS
• Independently organize and prioritize work to ensure the completion of audit timeframes

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What you need:

• High School diploma or GED equivalent required.
• Bachelor’s degree in a related field preferred.
• A relevant combination of education and experience may be considered in lieu of a degree.
• Certificate/License (CPC, COC, CRC, CCS-P CCS, CDEO, or CPMA) required.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward medical auditor certification is highly preferred and encouraged
• A minimum of 5 years of HCC-specific coding is required.
• Minimum of 1 year Risk adjustment auditing required.
• Understanding of CMS and ACA HCC Risk Adjustment coding and data validation requirements, and 1 year of CMS and HHS RADV audit experience in health plan operations is preferred.
• knowledge of RADV audits and Risk Adjustment.
• Strong analytical, planning, problem-solving, verbal, and written skills to communicate complex ideas.
• Ability to develop project management, meeting process, and presentation skills.
• Strong ability to work independently and direct the efforts of others.
• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
• Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York City, or Washington as set forth below.

Role Location: Range of Starting Pay for Role

Remote: $50,000-$70,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. Depending on the role, some associates may also be eligible for stock options.

What we believe:

We’re proud to embrace the same values that have shaped UST and its subsidiaries since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it’s those same values that are inspiring us to encourage innovation from everyone to champion ersity and inclusion and place people at the center of everything we do.

Humility: We will listen, learn, be empathetic, and help selflessly in our interactions with everyone.

Humanity: Through business, we will better the lives of those less fortunate than ourselves.

Integrity: We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

#Advantasure

Nurse Specialist – Clinical Review (2:30pm-11:00pm Eastern Time)

• Nursing
• Regular Full-Time
• Work From Home, United States
• 2150

Job Description

Job Summary

The Nurse Specialist – Clinical Review is responsible for utilizing their nursing knowledge and judgment in reviewing all client employee examinations, testing, and questionnaires, in consultation with Occupational Health Physicians, to determine ability to perform essential job functions.

Responsibilities

• Provide professional nursing review of occupational records for client employee medical surveillance, DOT, Hazmat exams, and return to duty exams.
• Interface with occupational health physicians for medical clearance.
• Work as customer service account representative for national occupational health clients.
• Review Pulmonary Function test and audiometric hearing exam.
• Document exams, laboratory and other occupational testing in database.
• Perform telephonic early intervention for client employees when an injury/illness occurs on the job.
• Perform additional duties and assume additional responsibilities as identified by manager for the efficient operation of WorkCare.

Qualifications

Education and Experience

• Associate degree or Equivalent, Bachelor’s Degree preferred
• Bilingual (Spanish) is preferred but not required
• Active RN or LPN License
• Certification in Occupational Health is a plus
• Minimum of 2 years nursing experience RN or LPN required
• Occupational Health Nursing a plus

Skills and Competencies

• Strong verbal, written and interpersonal communication skills.
• Must be able to demonstrate the ability of maintaining privacy and confidentiality.
• Strong critical thinking skills; problem solving, and decision making.
• Must have the ability to gather data, compile information and prepare reports.
• Ability to manage multiple priorities, with attention to detail and accuracy.
• Ability to create and edit written materials.
• Ability to communicate effectively to a variety of audiences.
• Skill in organizing resources and establishing priorities.
• Demonstrate cooperative behavior with colleagues, supervisors and clients.
• Strong time management, organizational, and follow-through skills.
• Ability to meet and exceed daily and weekly inidual performance goals.
• Ability to work independently as well as assisting other team members when needed.
• Requires regular and predictable attendance and punctuality.

Computer Skills

• Must be competent in the Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel, and PowerPoint) and learn other software as needed.

Physical Demands

• Requires sitting for long periods of time, working at a desk.
• Some bending and stretching could be required.
• Working under stress and use of computer/phone required.
• Manual dexterity required for use of computer keyboard.
• Occasionally may be required to stand, walk, stoop, kneel and/or crouch.
• May occasionally lift and/or move up to 15 pounds.

• Work Environment
  • Work environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled.
  • At home set up must meet all Company IT, privacy, and safety measures.

Additional Job Information

This is a fully remote position.

Work hours: Monday-Friday 2:30pm-11:00pm EST (Eastern Time).

This position has a salary range of $29.00-$31.00 per hour. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, experience and qualifications.

Benefits for this position include paid time off; medical, dental, vision, and critical illness insurance; HSA, HRA, and FSA; life and disability insurance; EAP; 401K; legal and identity theft coverage; pet insurance and more.

All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other classification protected by applicable laws. WorkCare is committed to providing access, equal opportunity, and reasonable accommodation for iniduals with disabilities in employment.

About WorkCare

WorkCare, Inc., is a U.S.-based, physician-directed occupational health company with global outreach.

Our mission is Protecting and Promoting Employee Health…from Hire to Retire. We believe Work Matters. Health Counts. Prevention Saves.

Our occupational clinicians and industry subject matter experts deliver integrated, total worker health solutions to employers in all types of industries. Our capabilities include Medical Exams & Travel program management; 24/7 Incident Intervention telehealth triage; Onsite Services & Clinics; Consulting Medical Directors; Clinical Accommodation and Leave Management support; and a full suite of COVID-19 interventions. Our Industrial Athlete and Bio-ergonomic Surveillance programs are designed to prevent and manage work-related strains and sprains.

Coding Analyst

Remote

Position Description

Eleanor Health is seeking a Coding Analyst with a strong background in medical coding and billing to join the Revenue Cycle team. The RCM Coding Analyst will be involved in all things behavioral health and substance use disorder treatment coding from beginning to end, including identifying workflow improvements and serving as a subject matter expert on coding for the Revenue Cycle team and the organization as a whole.

The Coding Analyst will work both independently and collaboratively to achieve revenue cycle goals, initiatives and ensure that daily workflows run smoothly.

Candidate Responsibilities

• Analyze and document the coding practices and workflow of Eleanor providers as well as identify and recommend potential workflow/practice improvements
• Correct rejected insurance claims and coding errors
• Execute monthly charge reconciliation for services and claims to ensure that all revenue is accurately captured and billed.
• Ensure that all claims are processed timely, and bundles created according to contract guidelines
• Drive world-class coding quality by helping to design and implement coding standards
• Develop insightful and comprehensive medical coding and billing analysis based on assigned payers
• Serve as the subject matter expert for medical coding and billing questions related to assigned payers
• Proactively stay up to date on coding and billing information, including policy and guidelines
• Drive coding team forward by constantly seeking and sharing ideas and solutions
• Create and leverage efficiencies in order to effectively balance a variety of projects and meet tight deadlines

Candidate Qualifications:

• 3-5 years of experience in medical coding and billing
• Strong experience working with CPT and ICD codes
• Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is preferred
• Prior startup experience preferred
• AthenaHealth experience preferred
• An analytic mindset – interested in root cause analysis and process improvement with the ability to work with and manipulate large amounts of data
• Solid background of developing informative and clear training/documentation materials

Competencies:

• Intellectual curiosity and creativity coexisting alongside critical thinking
• Ability to work efficiently under time pressure in a fast-paced and ever-changing environment
• Positive and patient team player
• Skilled at communicating across technical and non-technical audiences as well as with those who both do and do not have a medical coding background
• Detail oriented, committed to excellence and precision
• Outstanding written and oral communication and presentation skills

Benefits:

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• Flexible PTO policy and a remote work environment- unplug, relax, and recharge!
• 9 observed company holidays + 3 floating holidays- We encourage you to use the additional 3 floating holidays to accommodate personal beliefs/practices
• Wellness Days – In lieu of Sick Time which typically applies only when you are ill, we encourage you to proactively manage your overall wellbeing, both physical and mental, as well as the wellbeing of those who play important roles in your life.
• Fully covered medical and dental insurance plan, with affordable vision coverage.- We are a health first company, and we strive to make our plans affordable and accessible
• 401(k) plan with 3% match. We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity.
• Short-term disability- We understand that things happen, we want you to feel comfortable to take the time to get better.
• Long Term Disability – Picks up where Short Term Disability leaves off.

Life Insurance – Both Eleanor and employee-paid options are available.Family Medical Leave- Eleanor Health’s Paid Family & Medical Leave (PFML) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that they or a family member/significant other might be facing.

• Wellness Perks & Benefits- Mental Health is important to us and we want our employees to have the accessibility they deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
  • Mindfulness App Reimbursement
  • 1 year subscription to TalkSpace
  • Paid Membership to Health Advocate, One Medical, and Teladoc

About Eleanor Health

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, Florida, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers.

If you are passionate about providing high quality, evidence based care for iniduals with substance use disorder through an innovative practice and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate iniduals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Types: Full-time

Operations Associate – Credentialing

Remote

About us:

We’re on a mission to fundamentally transform mental healthcare accessibility. Grow Therapy empowers therapists to launch and grow thriving insurance-accepting private practices. We’re creating game-changing technology to build America’s biggest behavioral healthcare group and ensure that anyone can afford quality mental healthcare. Following the mass increase in depression and anxiety, the need for accessibility is more important than ever.

To make our vision for mental healthcare a reality, we’re building a team of entrepreneurs and mission-driven go-getters. Our founders come from Harvard Medical School, Stripe, and Blackstone, and are champions of balancing bold ambitions with a culture that promotes holistic well-being. Since launching in 2020, Grow has raised over $90M from top VCs and angel investors, including TCV, Transformation Capital, SignalFire, Village Global, CoFound, and leaders of Oscar, Nurx, Quartet, Airbnb, and Blackstone.

What You’ll Be Doing:

We’re looking for an experienced Operations Associate for our Insurance Operations team who is passionate about improving the landscape for mental healthcare. You’ll play an essential role in ensuring that our credentialing and/or revenue cycle management teams have the appropriate technological infrastructure in place to grow our provider base, get our providers in-network with the insurance companies, and obtain reimbursement for services to enable continued engagement and growth. You’ll thrive in this role if you love learning new software to enhance productivity and figuring out how to automate processes that are tedious and manual. As you get to know our internal systems better, you’ll have the opportunity to expand your impact into different areas of the business, and you’ll eventually become the go-to person for a myriad of responsibilities.

In this role, you will primarily be responsible for building and maintaining systems for submitting our insurance applications and rosters. This will involve researching, planning, and scoping out the process, implementing the protocol for our Credentialing Assistants to follow, and building out metrics to help track the success of our operations. This will require great communication skills as well as an eye for detail and organization in order to manage the process from start to finish.

• Build and maintain automated workflows to keep our processes running smoothly. You may do this yourself through no-code automation tools, or you may work with our Engineering team to help them develop and implement high-value features for our platform. This work will directly impact our ability to expand access to care nationally!
• Design and execute complex analyses to support decision making within Insurance Operations and across departments at Grow.
• Own and monitor metrics that track the health of our Insurance Operations. You’ll be responsible for identifying problems that may arise in our processes then working towards a solution.
• Collaborate closely with our Growth, Customer Support, and Technology teams to ensure stellar operational performance and service while we scale.

Salary range: $62,250-$91,675

You’ll Be a Good Fit If:

• A Problem Solver. You’re able to identify business challenges based on metrics and analyses, and you’re ready to recommend solutions to improve business processes.
• Mission-Driven. You’re here to change the world, and you’re always connecting your work back to the importance of the Grow Therapy mission.
• Agile. You thrive in a fast-paced, unpredictable environment, and you’re able to pivot as new priorities emerge.
• A Team Player. You’re collaborative by nature, relish in camaraderie and group wins, and are looked to by your colleagues as a steadfast partner and source of encouragement.
• An Excel Guru. You know your way around spreadsheets, and you’re able to write complex formulas and pivot tables. Bonus if you have a command of SQL.
• Previous experience with HubSpot, Zapier, and/or other automation tools is a bonus, but we prioritize capability over experience and are excited to invest in your professional growth.

If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.

Note: Please upload your resume in PDF format

Benefits

• The chance to drive impact within the mental healthcare landscape from day one
• Comprehensive health insurance plans, including dental and vision
• Our dedication to mental health guides our culture. Wellness benefits include (but are not limited to):
  • Flexible working hours and location (remote OR in-office, your choice!)
  • Generous PTO
  • Company-wide winter break
  • Mental health mornings (2 hours each week)
  • Team meditation
  • Wellness Stipend
  • In-office lunch and biweekly remote lunch on us!
• Continuous learning opportunities
• Competitive salary
• The opportunity to help build a rapidly scaling start-up organization by taking strong ownership of your work, mentorship, and our unbounded leadership opportunities

Title: Senior Director, Clinical Quality Assurance

Location: Hybrid, New Haven – Headquarters, Remote

Arvinas is a clinical-stage biotechnology company leading the way in targeted protein degradation therapeutics. Arvinas is the first company to focus solely on protein degradation and its platform technology is the most advanced in the field. Since its founding in 2013, Arvinas’ PROTAC Discovery Engine has been driving the most significant breakthroughs in the industry. Arvinas’ pipeline encompasses a range of validated and undruggable targets in oncology, immuno-oncology, and neuroscience. This includes three clinical-stage programs: bavdegalutamide (ARV-110) and ARV-766, which are being developed as potential treatments for men with late-line metastatic castrate-resistant prostate cancer, and ARV-471, which is being co-developed and commercialized by Arvinas and Pfizer as a potential treatment for patients with breast cancer.

#TeamArvinas is made up of more than 400 passionate and curious employees, whose erse thoughts and perspectives are highly valued. Arvinas employees embrace the freedom to pursue innovation, think creatively, and give back. They are driven by the company’s values and mission to improve the lives of patients with serious diseases by pioneering therapies created with our revolutionary PROTAC protein degradation platform. We’re really excited about the work we’re doing inside and outside of Arvinas, and think you will be, too. But don’t just take our word for it learn more about life at Arvinas and what employees have to say. For more information, please visit www.arvinas.com.

Position Summary

The Senior Director, Clinical Quality Assurance (CQA) is responsible for developing, maintaining and executing the requirements of the Arvinas Quality Systems as they pertain to clinical development of drug products by the company. The position provides direct Quality Assurance support for the Clinical Development and Clinical Operations functions, including the areas of clinical pharmacology, toxicology, pharmacovigilance, clinical trial conduct (Phase 1 – 4) and clinical data management. The position also contributes to the development, performance monitoring, and continuous improvement initiatives related to the company’s Quality Systems and their associated processes, policies, and procedures.

Under the direction from the Senior Vice President, Corporate Operations, the position provides quality assurance oversight and support for the various contract research organizations (CROs), clinical study sites and clinical service providers that perform GLP and GCP-related activities for the company.The incumbent works directly with the Arvinas Quality Team, Clinical Development, Clinical Operations, Regulatory Affairs, and the corresponding quality assurance staff of the various CROs, clinical study sites, and clinical service providers to ensure effective execution of the Arvinas Quality System requirements and compliance with the applicable GLP and GCP regulations / guidelines and industry standards. He/she also interfaces with representatives of similar responsibility from business partners working in collaboration with Arvinas to ensure effective delivery of joint projects/objectives.

This position reports to the Senior Vice President, Corporate Operations and can be located at our headquarters in New Haven, CT, or may be performed remotely from a location in the US.

Principal Responsibilities

Key responsibilities of this role include, but are not limited to:

• Quality Assurance oversight of activities performed at CROs and clinical service providers involved with the conduct of human clinical trials for Arvinas products. These activities may include, but are not limited to:
• On-site or remote / virtual auditing to support approval of new CROs; on-going qualification of existing CROs; or to investigate specific events involving GCP and GLP compliance ( for cause’ audits). Review and follow-up on audit responses from these clinical service providers to ensure appropriate corrective and preventive actions (CAPA) are assigned and executed.
• Provides Quality Assurance input / guidance regarding the handling of GLP/GCP compliance events that may occur to ensure these events are appropriately reported, investigated, and documented and that appropriate CAPA are identified and implemented, as appropriate.
• Provides inspection readiness support for key CROs and clinical study sites.
• Develops and approves Quality Agreements with key CROs and clinical service providers.
• Participates as a key member of internal and business partner project teams to ensure timely execution of responsibilities to meet the established project timelines.
• Serves as a standing member of the Arvinas Quality Board for the reporting of GLP and GCP compliance metrics, CRO audit performance, and recommendations to addresses areas of GLP and GCP compliance risk.
• Manages a team of Clinical QA professionals to ensure delivery of company and departmental objectives related to clinical development and GxP compliance. Manages contract support that may be required to support execution of CQA responsibilities.
• Provides support for regulatory inspection readiness initiatives, both internally and at Arvinas CROs and clinical sites, as appropriate.
• Performs verification reviews of clinical data and related information included with documents intended for subsequent regulatory submission or presentation at medical or investor conferences.
• Supports implementation of the Arvinas Quality Systems Plan, including the development, review and/or approval of Arvinas Quality System policies, procedures, and work practices associated with the GLP, GCP and GPvP requirements. Provides training to Arvinas colleagues and contractors on quality system requirements; conducts internal assessments and provides recommendations for improvements to existing quality system processes, policies, and procedures.
• Provides support for the implementation and qualification / validation of GCP/GLP-related computerized systems, as needed or requested.

Qualifications

• 15+ years of pharmaceutical clinical quality assurance experience in support of clinical development and clinical operations.
• Strong hands-on knowledge in the application and execution of GLP and GCP requirements.
• Experience with the application of phase-appropriate quality systems across the product development lifecycle (Phase 1 through commercial).
• Strong working knowledge in the application of the US and EU GCP guidelines, ICH Guidances, and industry standard requirements for Pharmaceutical Quality Systems. Experience in hosting regulatory inspections and in dealing with regulatory agencies throughout the drug product approval process.
• Strong communication skills (verbal / written).
• Ability to effectively communicate with business partners and third party clinical vendors and their quality assurance representatives to ensure Arvinas requirements are met and to resolve issues / discrepancies.
• Ability to prepare audit reports, quality agreements, standard operating procedures, and CAPA reports in accordance with Arvinas Quality System requirements.
• Oral and written presentation skills as needed to address colleagues at all levels of the organization, e.g., internal training presentations, presentation of CRO performance metrics, coordination of inspection readiness activities.
• Ability to work on multiple projects, manage competing priorities, and collaborate cross-functionally in a dynamic fast-paced environment.
• Hands-on experience with the use of electronic document management and QMS systems; Veeva Quality experience strongly preferred.

Education

• B.S. in a Healthcare-related scientific field. Advanced degree a plus.

#LI-Remote

Arvinas is proud to offer a competitive package of base and incentive compensation as well as a comprehensive benefits program designed to support the health, wellness and financial security of our employees and their families. Benefits include group medical, vision and dental coverage, group and supplemental life insurance, and much more. To learn more about Arvinas, please visit www.arvinas.com

Arvinas is an Equal Opportunity Employer

Title: Certified Medical Coder – Anesthesia

Location: US National

FULL-TIME/ REMOTE

At Zotec Partners, our People make it happen.

Transforming the healthcare industry isn’t easy. But when you build a team like the one we have, that goal can become a reality. Our accomplishments can’t happen without our extraordinary people those across the country who make up our erse Zotec family and help make this company a best place to work.

Over 20 years ago, we started Zotec with a clear vision, to partner with physicians to simplify the business of healthcare. Today we are more than 1,000 employees strong and we continue to use our incredible talent and energy to bring that vision to life. We are a team of Innovators, Collaborators and Doers.

We’re seeking a Certified Medical Coder to join us.

As a Certified Medical Coder, Anesthesia , you will be responsible for the full process of coding Anesthesia coding reports.

What you’ll do:

• Code Anesthesia coding reports
• Resolve coding issues
• Respond to coding related denials
• Take steps to correct claims
• Submit appeals
• Investigate and resolve reports submitted for coding investigations

What you’ll bring to Zotec:

• Current Certification AHIMA or AAPC
• Completed ICD10 Certification/Training, preferred
• 2+ years of experience coding Anesthesia coding reports
• Ability to work on internet based coding programs
• Thorough knowledge of medical office operations
• Proficiency in Microsoft Work, outlook and Excel
• Excellent communication and problem solving skills
• Capable of prioritizing work flow and able to ensure deadlines are met
• High school diploma or equivalent

Title: Registered Nurse

REMOTE Per Diem Bilingual RN – $38/hour (NY Licensed)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

At Vesta Healthcare, we enable people with personal assistance to thrive at home, in their community by assuring the people they rely on, their caregivers, have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise. Our analytics help identify and target the right people and populations. Our technology creates real-time connectivity and actionable data out of observations. Our services connect to real people who can help when needs arise, and our healthcare expertise helps us understand how we create value for both payers and providers.

Vesta Healthcare partners with physician groups and home care agencies to help implement and deliver these services; providing administrative support, and helping to find committed and capable staff for the physician group.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A Registered Nurse with availability to work a minimum of 24 DAYTIME hours a week either Monday through Friday or Friday through Sunday from the comfort of their own home. The RN must be experienced in triaging older adults and the elderly population and is conducted telephonically in a model with nurse practitioners for collaboration. You will play an integral role in reducing unnecessary utilization of the Emergency Room and maintain the patients’ independence and safety at home.

The ideal candidate would be able to:

• Speak with the member, family or caregiver
• Have confidence in the ability to recognize clinical scenarios that require escalation to the internal team nurse practitioner
• Have excellent customer service
• Have the ability to educate members, family or other caregivers on chronic conditions, diet changes, and medications.
• Utilize technology for documentation
• Have the confidence to work in a fast paced environment
• Have a quiet work environment in your home with high speed internet
• Coordinate care appropriately and timely with members of the care

Would you describe yourself as someone who has:

• Ability to fluently read, write, and speak Spanish or Cantonese or Mandarin or Russian AND English (required)
• Graduated from an accredited nursing program (required)
• Current RN License in the state of New York (required)
• The ability to work a minimum of 24 hours a week (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• Confidence with clinical skills in performance of telephonic triage (required)
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• At least 2+ years of emergency department/care management, urgent care, and/or triage experience (preferred)
• At least 2+ years of chronic care management experience with the geriatric population (preferred)
• A genuine, compassionate desire to serve others and help those in need

Pay range is $38 per hour.

If yes, then we look forward to speaking to you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.

Subrogation Investigation Specialist

Job Locations: US-Remote

ID2023-10486

Category

Audit – Healthcare

Position Type

Full-Time

Overview

We are seeking a talented inidual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement

The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources.

Responsibilities

You will work directly with our client’s membership, insurance adjusters, and attorney’s to:

• Recovery Function Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures
• Comply and be knowledgeable of all federal and state laws governing the collection of accounts
• Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to account
• Negotiate payment arrangements within established guidelines
  Investigative Function – Research claims as investigative support for the company to maximize profits of each account worked
• Determine if a case has third party liability potential
• Work collaboratively with internal and external contacts to determine account liability
• Assign file to a Recovery Specialist after detailing investigation claims
• Coordinate benefits with no fault and first party auto carriers
• Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements
• Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client
• Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details
• Investigative claims and accident details to identify recovery potential
• Update internal systems with information obtained and actions taken on account
• Ensure proper notification per client guidelines
• Effectively work, maintain, and manage a variety of cases with current and accurate notes
• Meet department objective standards for Customer Service.
• Follow account process to ensure proper investigative steps are taken on each account
• Follow client and state guidelines for determining potential for recovery on behalf clients
• Develop templates for system training materials based on the training strategy
• Deliver specific application training based on use needs analysis
• Create and document training materials based on key functionality across the application
• Coordinate with product teams to keep training materials current with updated functionality and features
• Develop additional system support materials such as user job aids

Qualifications

• High School diploma or GED required
• Minimum 6 months experience in health insurance industry, medical claims, data entry, or customer service required
• Basic knowledge of Microsoft Word and Excel required
• Basic computer proficiency required (typing, ability to navigate various websites)
• Ability to work independently to meet objectives
• Ability to perform well in a team environment
• Strong verbal and written communication skills
• Ability to be thorough and detailed when speaking over the phone or entering data
• Ability to interact with all levels of people both internally and externally in a professional manner
• Working knowledge of HIPAA privacy and security rules
• Ability to maintain a high level of confidentiality and ethics
• Basic knowledge of health insurance coverage and/or terminology preferred
• Ability to organize information to be shared to parties as required
• Ability to meet deadlines
• Bilingual (Spanish & English) a plus

Base compensation ranges from $15.20 to $18.40. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

#LI-KB1

#Remote

#associate

Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes iniduals based on their qualifications for a specific job. Cotiviti values its erse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Clinical Operations Specialist

REMOTE

United States

Operations

Full time

Description

About Hone

Hone is a modern hormone therapy company that makes it easy for men to get back their energy, focus, and confidence. Our mission is to empower men to take back control of their health and feel like themselves again, all from the comfort of home. Our vision is to live in a world where age isn’t a limit.

Since launching in 2020, we have helped tens of thousands of men test their hormones and connect with leading hormone therapy specialists all over the country using telemedicine. We are expanding into additional therapeutic areas (like weight loss) and women’s care.

The Role

Are you passionate about helping people get back to feeling their best? Do you want to be part of the fastest-growing men’s healthcare company in the country? Are you excited about working with new technology, including an innovative new EMR built by our engineers? Are you a people person who loves to make new friends and collaborate with different teams? If so, we want to work with you.

Hone is looking for a Clinical Operations Specialist to join our team. As someone with a clinical background, you are responsible for supporting doctors and their patients with their medical care. You will review, triage, and escalate physician and patient issues in collaboration with the customer service, clinical, and operations teams so that Hone patients have the best experience on our program. You must thrive in a fast-paced environment that requires excelling in an unstructured setting and thinking outside the box.

Requirements

• Own patient communications for clinical questions (e.g. side effects, prescriptions, labs) and know when to escalate the issue.
• Work with the clinical and operations team to make sure the patient receives fast resolution to any concerns.
• Support physicians to ensure any patient care issues are resolved in a timely manner.
• Follow established protocols and processes, with an eye towards improving operational processes to provide the best patient experience.
• Be willing to take on additional clinical projects or responsibilities when necessary.

Qualifications

• Medical background
  • RN or equivalent degree, preferred
• Very comfortable using common technology platforms (e.g. Gmail, Google Docs, Google Sheets, Google Meet).
• Can quickly learn new technology systems (e.g. Hone’s EMR) and communication tools (e.g. Slack, Zendesk).
• Demonstrated attention to detail and problem-solving skills.
• Organized multitasker.
• Effective and compassionate communicator (written and verbal).
• Ability to work autonomously and collaboratively.
• Must be a self-starter who looks for opportunities for improvement regularly.
• Preferred, but not required: Knowledge of testosterone deficiency in men.

Benefits

• Competitive salary, equity, and career development opportunities.
• Health, dental, and vision insurance plan coverage.
• Budget for the technology tools you need (laptop, monitor, and/or special software).
• Remote-first company.
• Company vacations and get togethers to build community.
• Generous vacation and sick days.

We are proud to be an equal-opportunity workplace committed to building a team culture that celebrates ersity and inclusion. We will ensure that iniduals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions. Please contact us to request an accommodation.

Registered Nurse (RN) – Remote Work from Home $ 34.00/hour!

Job Location US-TX-Austin

ID2023-3370

Category

Healthcare Support

Position Type

Regular Full-Time

Are you…?

Looking for a registered nurse position that is challenging, will keep your clinical skills sharp, but being doing so from the comfort of home.

Compassion-driven, self-motivated, high-performing registered nurse.

Your critical thinking and clinical skills are top-notch.

Ready for a fast-paced position where you interact with patients through innovative channels, while keeping your clinical abilities sharp.

Want to work for an organization poised for unprecedented growththat offers work-from-home options

Then we should talk.

Responsibilities

Carenet Healthcare Services is seeking RNs (Registered Nurses) to join our team of talented professionals who provide telehealth and virtual care clinical triage assessments, health education and other services to erse populations of patients and health plan members.

At Carenet Health, our nurses play an important role in helping healthcare consumers live their healthiest lives. You may not know our name, but odds are, our nurses or clinical staff have connected with you or someone you know as a trusted, behind-the-scenes partner for our clients250+ of the nation’s premier health plans, health systems and their partners.

About 50,000 times a day, our compassion-focused teams guide people via phone, video, chat and other channels to high-quality and cost-effective care, coach them to improved wellness, and educate them about their healthcare resources and costs.

Our nurses and clinical staff support patients across the U.S. and around the world. Our fast-paced positions offer innovative work-at-home capabilities, plus the opportunity to keep your clinical skills sharp and have meaningful interactions with patients in a less physically demanding setting than a traditional clinical environment.

We take great pride in our disciplined, evidence-based protocols and inidual care approach. Our most effective clinical team members combine clinical expertise, critical thinking and the ability to develop a virtual, meaningful rapport in an empathetic way By focusing on one patient at a time, you’ll leverage your clinical expertise, quick thinking and problem-solving skills to make a difference in thousands of lives every year.

Is this you?

Bring empathy and a passion for evidence-based care to all you do. Multitasking and attention to detail are your superpowers. You have a strong clinical background and believe part of your job as an RN is to advocate for your patients. You roll with the punches on any given day, with any given interaction, and never lose sight of the need to use your stellar interpersonal and quick assessment skills. You respect different cultures and know that rule-following is essential to your personal integrity and your employer’s quality compliance.

Atypical week in the life of this position:

Work independently to make clinical decisions on routine patient care matters (at your license level) Provide patient-focused care and guidance on the phone or online, including accurately assessing needs, delivering or directing to the appropriate level of care, identifying potential health problems and influencing people to make better health decisions Communicate with our organization’s clients as needed and other team members, verbally and digitally Monitor your own performance with dashboard metrics and look for ways to improve Participate in coaching sessions to improve performance Document all patient/member interactions via management software

For eight consecutive years,Inc. Magazinehas named Carenet as one of America’s fastest-growing private companies. You may not know our name, but odds are, we have connected with you or someone you know as a trusted, behind-the-scenes partner for our clients.

What’s important to us?

Being an integrity-driven organization that can truly change people’s lives Serving others joyfully and iniduallywe’re driven by the power of personal connection Pioneering next-generation healthcare consumer and clinical engagement experiences An entrepreneurial mindset A work/life balance

Qualifications

What’s required:

A min of 3 years as a Registered Nurse with recent direct patient care experience; Three (3) years preferred in a high acuity level i.e. ICU, CC, ER, med-surg, telemetry, and or Tele – Health, Telephonic Triage. Must currently reside and have a Multi-State (compact) unrestricted RN license in one of the following states: AL, AR, CO, FL, GA,IA, ID, IN, KS, KY, LA, ME, MS, MO, MT, NE, NM, NC, ND, NH, OK, SC, SD, TN, TX, VA, WI, WY Ability to become licensed in additional states as required

Minimum of an associate’s degree from a two-year technical college or technical school, or diploma nursing program; Bachelor’s degree preferred

More important information:

Full-time positions available (36-40 hours per week) Your schedule will include at least two weekend days every two weeks. Differential pay may be earned for certain shifts. Training is2-3 weeks, with the firsttwo weeks during daytime hours.100% Attendance is required. Training is done in a virtual, interactive classroom setting. For work-from-home positions, your home office must meet certain certification requirements that would be explained to you during the interview process.

Call Center Clinical Pharmacy Technician – Remote

locations

Home

time type

Full time

job requisition id

R-09739

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Call Center Clinical Pharmacy Technician – Remote

Job Description Summary

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

Job Description

• As a Call Center Clinical Pharmacy Technician working remotely, you will be responsible for high volume inbound call center serving calls from Members, Pharmacies and Prescribers for Medicaid/Medicare or commercial pharmacy benefits management business.
• You will be evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
• Your performance measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
• You must be available to work a set schedule during training and must be available and commit to work any assigned shift between the hours of 8AM and 10PM ET daily including weekends and holidays.
• You will determine appropriateness for medications and communicate decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will research, resolve and document prior authorization outcomes in pharmacy system.
• You will communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will escalate requests to Pharmacist when request requires extensive clinical review or denial.
• You will research, resolve and document physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• You will perform other duties as required.
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).

Responsibilities

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.
• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
• In states that do not require licensure or registration, or that restrict licensure to employees of dispensing pharmacies, must have an active national certification (e.g., PTCB or ExCPT).
• Active Pharmacist license supersedes requirement for CPT and/or PTCB.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Excellent written and verbal communication skills.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to identify and trouble-shoot problematic issues.

Work Experience

Work Experience – Required:

Pharmacy

Work Experience – Preferred:

Education

Education – Required:

GED, High School

Education – Preferred:

Certifications

Certifications – Required:

CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements – Pharmacy – Pharmacy

Certifications – Preferred:

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage erse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Scheduling Specialist

Remote

Full Time

Entry Level

About Us

Upperline Health launched in 2017 and is one of the nation’s leading comprehensive and coordinated lower extremity healthcare organizations. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Indiana, Kentucky, Georgia and Tennessee.

Benefits

Comprehensive benefit options include medical, dental and vision, 401K and PTO.

About the Scheduling Specialist Role

Upperline Health Indiana is seeking a Scheduling Specialist to support our team of clinicians in delivering complex health services in the clinic setting. This person will be based REMOTELY but in Indianapolis, IN area and will be responsible for performing centralized appointment scheduling and a variety of clerical tasks. Candidates must possess excellent customer service skills and an engaging and professional phone presence. Responsibilities will be varied, and requires multitalented, flexible problem solvers who are eager to tackle complex problems and thrive in a fast-pace environment.

Scheduling Specialist Responsibilities

• Provide telephone scheduling support to our podiatric clinics
• Schedule patients via office scheduling policies and confirm appointment times
• Educate patients on the impactful services of Upperline Health Indiana clinics
• Answer and screen in-bound calls, take messages, and provide appropriate information to patients
• Proactively handle outgoing phone calls including, but not limited to appointment confirmations, referral calls, and pre-certifications
• May be requested to support and perform other duties based on business demand

Scheduling Specialist Experience Qualifications

• Minimum of one year of experience in a call center, managing a call queue or medical appointment scheduling
• Experience scheduling for multiple-doctors and locations and/or high-volume scheduling
• Bi-lingual (English and Spanish) is a plus
• Familiarity with health insurance plans is required
• Previous experience in a clinic or hospital setting handling patient interactions
• Previous working in a Practice Management and EHR system Athena system experience preferred
• Exceptional customer service orientation featuring an empathetic, compassionate and professional demeanor with each interaction
• Must be an effective communicator with excellent grammar and interpersonal skills
• Excellent data-entry skills and proven ability to navigate multiple computer systems, including uploading documents and faxing
• Demonstrated experience as a motivated and dedicated team member with a stable work history
• Thrives in a fast-paced environment that relies on the ability to multi-task, energy and drive balanced with sensitivity and compassion

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time

Coding Specialist

Location: Remote

How will this role have an impact?

As a Coding Specialist you will review and evaluate health assessments/evaluations to assign, edit and/or validate the appropriate ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis. A Coding Specialist performs coding and/or code validation across multiple entities by applying all appropriate coding guidelines and criteria for code selections.

This role will report to our Senior Coding Manager!

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

What will you do?

• Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis.
• Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk assessments/evaluations.
• Reviews health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the
• assessment/evaluation on a timely basis.
• Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk
• assessments/evaluations.
• Understanding the relationship between ICD-10 coding and HCC (hierarchical condition category) coding.
• Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Sr. Coding Manager to ensure the organization is
• following Medicare coding protocol for payment of claims.
• Demonstrate a commitment to integrating coding compliance standard into coding practices. Identify, correct and report coding problems.
• Maintain adequate knowledge of coding, compliance and reimbursement procedures related top Medicare Risk Adjustment.
• Make recommendations for coding policy/changes.
• Maintain coding certification after achieving certification status.
• Complete special projects as assigned by management, which require defining problems, and implementing required changes.
• Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities.

We are looking for someone with:

• Must hold an active CPC, CPC-A, COC, CCS, CCS-P or CCA
• Current coding certification in good standing.
• CRC preferred
• ICD-10 Coding Certification will be required
• Minimum of 0-5 years of ICD-10 coding experience.
• Prior work experience in the healthcare field specifically related to coding is preferred.
• Experience and knowledge of Medicare HCC coding.
• Experience with medical record documentation.
• Prior medical chart auditing/quality experience preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across iniduals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for iniduals who need help the most. This leads to better outcomes and a better experience for everyone involved.

Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million iniduals each year while helping payers and providers more effectively implement value-based care programs.

We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.

To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.

#LI-RD1

#REMOTE

Medical Insurance Verification Specialist

ORLANDO, FLORIDA

FINANCE

FULL-TIME

REMOTE

ABOUT US

Circle Medical is a venture-backed Y-Combinator healthcare startup on a mission to bring quality, delightful primary care to everyone on the planet. Built by top-tier physicians, engineers, and designers, our medical practice and underlying technology have pioneered how people find and receive care.

Our focus on building directly for our patients and providers to address serious care accessibility issues has enabled us to grow over 3X year-over-year. We’re now using our most recent round of funding from WELL Health, backed by Sir Li Ka-shing, to continue building out our hybrid in-clinic and telemedicine model across all fifty states.

As we enter the hypergrowth phase, we are looking for deeply motivated team players who are driven to solve some of the biggest challenges in healthcare so that people can live longer and healthier lives.

More about us can be found on our website.

DESCRIPTION

We are currently looking for a Medical Insurance Verification Specialist to join the Finance team at Circle Medical Technologies. As we continue to grow, we are constantly searching for exceptional talent to be a part of our team. This position will be remote in the U.S. for the right candidate.

WHAT YOU’LL DO

• • Accurately carries out the responsibility for verifying patient insurance coverage and ensures that necessary visits and procedures are covered by an inidual’s provider
  • Demonstrates proficiency in working with insurance companies (phone, chat, website) and has extensive knowledge of different types of coverage and policies
  • Forwards patients who have outstanding balances to a Billing Representative
  • Maintains and adheres to the company’s HIPAA and Compliance regulations

WHAT YOU’LL BRING

• • Proficient with Google Workspace, Microsoft Office Suite, or related software
  • Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented, organized, and maintains accurate patient insurance records
  • Uses good judgment in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient’s insurance premium was not paid)
  • Utilizes patient charts on an as needed basis, accessing only information related to treatment, payment, and health operations
  • High speed internet access required

EDUCATION & EXPERIENCE

• • High School diploma or College Degree (preferred)
  • At least two years prior insurance verification experience in a medical office, hospital facility, or call center (required)
  • Knowledge of customer service principles and practices

WHAT WILL GIVE YOU AN EDGE

• • Proven track record with other startups or VC funded companies
  • Is proficient in the use of Availity and insurance-specific portals to accurately verify insurance coverage and patient responsibility

COMPENSATION

In alignment with our values, Circle Medical has transparent salaries based on output levels, and options to trade cash for stock.

This is a full-time, hourly, non-exempt position with an hourly rate of $20.42 to $24.50 plus generous vacation, and full medical/dental benefits.

Telehealth Triage Nurse

Location: United States

Remote – Part Time to Full Time

Telehealth Triage Nurse (Remote)

Fonemed is recruiting remote Registered Nurses to join our team! We are looking for experienced and dependable Registered Nurse who are dedicated to providing quality nursing care to patients. If you are a Registered Nurse who is looking for a challenge and a company who values you, apply today!

With over 20 years in the telehealth industry servicing clients across North America, Fonemed prides itself on providing outstanding client experience and practicing a culture of care in everything we do. If you are looking for an opportunity to practice your nursing skills from home and work for company that values you, apply today!

Position Overview

Our nurses provide telephone triage and health advice to callers across the United States remotely from the comfort of their own home using world renowned Schmitt-Thompson protocols and provide nursing care advice virtually to patients. Calls received can vary greatly in subject matter and complexity. In addition to triage calls, we receive questions requesting information on medical conditions, medications, diagnostic tests, etc., and provide patient support through addressing their medical questions and concerns.

Registered Nurses must be attentive and engaged listeners who have strong critical thinking and clinical assessment abilities and are able to make decisions independently and document clear clinical data. All calls are documented electronically, and all telephone encounters are recorded.

Role Responsibilities

• Provide telephone triage and advice to callers to assist them in making timely medical decisions
• Exercise clinical judgment in combination with utilization of protocols to arrive at the appropriate disposition to provide timely and accurate level of care to patients
• Promptly complete confidential medical records as per company documentation standards
• Provide clear and concise information and direction during patient encounters

Shifts and Scheduling

• Fonemed is a 24/7 operation, meaning shifts can include days, evenings, overnights, weekends and holidays, with staggering starting times for operational needs
• Our highest operational need at this time is during weekend afternoons on both Saturday and Sunday
• Please note, there are no permanent overnights currently available as our overnight team is full. Permanent overnight requests will be considered based on seniority when space allows
• Part Time options available:
  • 0.5 FTE 20 hours/week working every weekend with 1-2 short evening shifts per week.
  • 0.5 FTE 20 hours/week working 3 weekends on/1 weekend off with 1-2 short evening shifts per week please note in this option, the week with your weekend off you would be scheduled more throughout the weekdays to account for the 20-hour work week.
  • 0.25 FTE 20 hours biweekly working every second weekend with 1-2 short evening shifts over a 2-week period.
  • Full time opportunities will be considered depending on factors such as licensure, availability, fluent languages, etc. and will be evaluated to determine eligibility.

Expectations of Nurse

• Private HIPAA compliant home office with high-speed internet connectivity (wired/ethernet highly recommended)
• Must be able to provide own computer equipment (computer or laptop, second monitor, keyboard, mouse, wired headset and high-speed internet)
• Participation (via telephone or video) in staff meetings
• Full compliance with FONEMED policies and procedures, including HIPAA privacy requirements
• Provide patients your dedicated, unided attention during your calls

Qualifications and Experience

• Completion of a recognized Nursing program
• Minimum 3 years of recent clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU
• An active license in CA is required, along with active license in your home state.
• Active RN license in the following states would be considered an asset: AK, PA, NY, OR and WA
• Active licensure in all 50 states would be an asset or the willingness to obtain licenses at the company’s request
• Previous telephone triage experience using electronic triage software and computerized medical protocols will be considered an asset
• Experience using the Barton Schmitt/David Thompson guidelines will be considered an asset
• Strong communication skills
• Strong clinical assessment skills
• Strong computer skills within a Windows environment and keyboarding ability
• Bilingual English/Spanish or another language will be considered an asset

Why Work With US:

• Competitive hourly pay, with shift differentials for overnight and weekend hours
• Company reimbursement for licensure costs
• A comprehensive training and orientation program with a supportive team of co-workers and managers
• A friendly and collaborative work environment from a company who values our employees
• Recognition of employee achievements and milestones

Telehealth Triage Nurse

Remote

Part Time

Mid Level

SHARE

Since 2004, Sequence Health has offered a wide breadth of innovative patient engagement and patient management solutions to help optimize operational efficiency, elevate brand awareness, and grow physician practices and healthcare businesses.

We are seeking a Registered Nurse who will provide nursing and administrative support to a range of practices across the country. Candidates should have strong computer skills and excellent phone skills to work with providers, patients, and administrators. This position will be for overnight and weekend work, potential day shifts available.

Essential functions include:

• Receive inbound calls from patients and place outbound calls to patients.
• Provide clinical assessment based on established protocols and triage patients by phone or through patient portal.
• Respond to patients’ messages in patient portal, create orders and route to appropriate parties.
• Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD
• Communicate with Health Care Provider through approved methods as needed.

Qualifications:

• Registered Nurse
• Current demonstration of clinical proficiency
• Excellent written and oral communication skills
• Excellent critical thinking and problem-solving skills
• Ability to work within approved procedure and clinical guidelines
• Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway
• Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others

Minimum Requirements

• Registered Nurse with Unencumbered e-NCL Licensure. Licensure in Nebraska, California licensure required.
• Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women’s Health or Labor and Delivery experience preferred.
• Able to work remote at home in a private HIPAA compliant workspace
• Able to house company equipment needed to perform job
• Broadband Internet Access
• Immigration or work visa sponsorship will not be provided
• Physical Demands:
• Ability to hear in normal range and wear a headset / earpiece
• Good visual acuity to read computer screens, scripts, forms etc.
• May sit 100% of the time when taking calls

Title: Provider Solutions Associate

Location: Remote – USA

Clover is reinventing health insurance by working to keep people healthier.

The Provider Solutions team ensures that Clover is successfully managing our contracted providers’ most complex operational needs. The Provider Solutions team will serve as a conduit between Clover and our providers to diffuse and resolve critical payor-provider escalations. The Provider Solutions team will work with operational leaders across Clover, including, but not limited to Provider Data, Claims, Configuration, Payment Integrity, Customer Experience, Network, and Finance to optimize Clover’s provider relationships.

As a Provider Solutions Associate, you will play a vital role in strengthening provider relationships through resolution and education of complex provider issues. We are looking for a candidate with experience in health plan operations and a thorough understanding of the provider/payer dynamic and claims processing. Additionally, the ideal candidate will be comfortable interacting with administrators and executives within provider organizations as well as within Clover. The candidate should have a strong ability to synthesize issues, create a plan for resolution, and effectively communicate to all parties.

Come be at the heart of the action!

As a Provider Solutions Associate, you will:

• Be the subject matter specialist on all the Clover Health Operational area processes including: Contracting, Payment Integrity Audits, Member Grievances, Claims Configuration, and Processing.
• Lead projects to improve the overall provider experience.
• Become the designated representative for high priority providers and lead external calls on a monthly cadence and/or as needed.
• Research, resolve, and respond to provider-related escalations received internally and externally.
• Work cross-functionally with internal teams to research and resolve standard provider escalation issues including but not limited to claims, contract, provider data/directory, configuration, payment integrity and payment issues.
• Outreach to provider groups as needed to educate providers on network status and new Clover policies, initiatives, and best practices.
• Assist in identifying opportunities for process and technology improvements to drive down provider abrasion.
• Escalate issues to The Provider Solutions Management team when appropriate.
• Manage and/or support other projects and activities as assigned.

You will love this job if:

• You want to make an impact. You thrive off of helping others and want your work to make a difference in our providers’ lives, while also advocating for their needs.
• You are a team player. You know how to communicate effectively to build trust and lasting partnerships with many different types of people, teams, and stakeholders.
• You are a strategic prioritizer. You are able to identify where and when to focus your energy.
• You enjoy technology. You like learning about new programs and leveraging them to solve large issues.
• You have a critical and analytical mindset. You are able to break down complex information and/or comprehensive data into basic principles in order to make a thoughtful decision.

You should get in touch if:

• You have 3+ years experience in the health and medical insurance industry.
• You are proficient in Data Analytics and a multitude of programs including but not limited to: Microsoft Excel, Salesforce, JIRA, Mode, and Google Suites.
• You are a certified professional coder, preferred but not required.
• Understanding of healthcare topics such as: claims processing, prior authorizations, medical billing and coding, payment integrity and reimbursement practices for physician and facility services.
• Understanding of compliance and payer requirements, including but not limited to CMS Medicare regulations and guidelines.
• Understanding of interpreting medical records, CPT and ICD-CM coding guidelines.

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven iniduals with erse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

Account Representative III

Remote Location

Full time

219669

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title: Account Representative III

Location: Cleveland

Facility: Remote Location

Department: RCM Special Billing-Finance

Job Code: U18025

Shift: Days

Schedule: 8:00am-4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As an Account Representative III, you will perform a specific operational responsibility within a revenue cycle management functional unit including customer service, insurance billing and follow-up processes for commercial and government payers, insurance verification, cash application, credit balance resolution, and/or account reconciliation. The ideal future caregiver is someone who:

• Is engaged with their job responsibilities.
• Thrives working both independently and as part of a team.
• Acts in a professional, caring, and helpful manner.
• Is an effective communicator.

By taking this opportunity, you’ll have the opportunity to learn and develop within the team as well as advance your career into positions such as CSR I, II, III, Work Leader, and more.

At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Job Details

Responsibilities:

• Recommends and provides input to execute customers service programs in accordance with changes in insurance reimbursement regulations and data obtained from various groups.
• Provides supervisor/manager with information to assist department liaison with various departments in regards to various issues including but not limited to contract and reimbursement rules. Complies, recommends and assists with the implementation of various management reporting systems to insure accurate and timely reporting of department goals and results.
• Assists with department audits as required. Participates in meetings with various payors, internal billing groups and other CCF departments to address discrepancies in payment and provides summary data and trend analysis to Managed Care Business Development for use in contract negotiations.
• In conjunction with supervisor, recommends changes in billing practices intended to reduce payor mis-adjudication of claims and identifies contract language or specific payment methodology contributing to errors in payment.
• Maintains data and develops enhancements to database and other various management reporting systems to insure accurate presentation of trends in payor reimbursement, error rates, and maximize recovery of underpayments.
• Validates new and existing contracts and reimbursements rules/logic.
• Other duties as assigned.

Education:

• High School Diploma or GED required.
• An Associate’s Degree may offset one year of required experience.
• A Bachelor’s Degree may offset two years of the required experience.

Certifications:

• None required.

Complexity of Work:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Work Experience:

• Minimum of three years patient accounting experience.
• An Associate’s Degree may offset one year of required experience.
• A Bachelor’s Degree may offset two years of the required experience.
• Knowledge of patient accounts which includes customer service, insurance processing, insurance verification and cash application.
• Knowledge of additional specialized function may be required such as third party payors, Medicare processing, hospital and physician billing and pricing, CPT4/ICD code application.
• Must have excellent verbal and written skills.

Physical Requirements:

• Ability to communicate and exchange accurate information.
• Ability to perform work in a stationary position for extended periods.
• Ability to work with physical records or operate a computer or other office equipment.
• In some locations, ability to travel throughout the hospital system.
• In some locations ability to move up to 25 lbs.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after 90 days.

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID-19, or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Title: Primary Care Telehealth Nurse Practitioner (Part Time)

Location: United States

Hello! We’re Babylon, a leading digital healthcare company.

Our mission is to make high-quality healthcare accessible and affordable for everyone on Earth. Building on the success of Babylon in the United Kingdom, Rwanda and Canada, we are building a 50-state provider network in the United States. We want to provide health services to the Medicaid population, who are often underserved and overlooked. Today, we cover over 3.5 million members in the US.

By shifting the focus from sick care to preventative care, we’re creating a better model of healthcare. One that combines AI-powered technology with the highest quality clinical expertise so we can help people live healthier, longer lives. With over 2,000 global employees, we’ve brought together one of the largest teams of healthcare professionals, scientists, mathematicians and engineers.

Our talented team is looking to hire the best clinicians and operations talent to build and scale in the US. We’re driven by people whose ideas and energy align with our mission and our values: to dream big, build fast and be brilliant.

The Opportunity

Babylon is hiring part-time Family Medicine or Medicine-Pediatrics Nurse Practitioners to help us redefine the healthcare landscape in America. As a Babylon Provider, you’ll get the opportunity to work with a global digital healthcare and AI company that is truly making an impact across the globe. To support our mission to provide affordable and accessible healthcare, this position is 100% remote and supports a national primary care service.

WHAT YOUR WORK WILL ENTAIL:

• Provide the full scope of primary care and urgent care services which fall under his/her field of training, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients.
• Orders or executes various tests and diagnostic images to provide information on a patient’s condition.
• Reviews incoming reports (e.g. lab, x-ray, EKG) signs, dates and follows-up with results in the timeframe outlined in Babylon policies
• Educate patients regarding health and illness prevention. Recommend community resources to meet patient and family needs.
• Administers or prescribes treatments and medications, and instructs patients on proper utilization.
• Supervises and collaborates with advanced practice nurses, physician assistants, and clinical pharmacists
• Close collaboration with scheduling and nursing support teams
• Close collaboration with other care team members, including but not limited to behavioral health providers
• Provide coordinated care services and lead care teams as necessary to provide appropriate care based on evidence-based guidelines
• Flexibility in scheduling to facilitate us staffing our primary care service 365 days a year

Qualifications (NP):

• 3+ years of experience post licensure as a Family Nurse Practitioner
• FNP (Telemedicine experience preferred)
• Active state license (Medicare and Medicaid enrolled preferred)
• Proficiency with Electronic Medical Records and other technologies (Athena preferred)

WHAT WE OFFER:

• Competitive compensation
• Medical Malpractice Coverage
• Medical, Dental and Vision Insurance (full-time only)
• License renewal and/or reimbursement as well as opportunity to obtain additional licenses based on business needs and growth.
• We provide a full training program and a supportive environment to help improve your video consultation and clinical skills, including ongoing appraisals and peer reviews
• CME 5 days and $1000 a year for full-time providers, prorated for part-time.
• 4 weeks’ accrued paid vacation
• 401k with employer matching contribution
• Incredible growth opportunities with a global health tech startup with a meaningful mission

#LI-remote

Salary Range Disclosure (US ONLY)

At Babylon the US base compensation for this part-time position is $67.31/hr – $70.67/hr. The range displayed reflects the minimum and maximum target for new hire salaries across all locations in the US. Within the range, inidual pay is determined by work location and additional factors, included job related skills, experience, and relevant education or training.

Compliance Disclosure (US ONLY)

If you are a Babylon employee who is also a California resident, under the California Consumer Protection Act of (2018) as amended, you have a right to:

• know about the personal information Babylon collects about you and how it is used and shared;
• correct inaccurate information;
• delete personal information collected from you (with some exceptions such as if it is still needed for the purpose for which it was provided or if we are required by law to maintain it);
• limit the use and disclosure of your sensitive personal information;
• opt-out of automated decision-making technology;
• opt-out of the sale of your personal information; and
• non-discrimination for exercising your CCPA rights (including employment decisions or retaliation).

WORKING AT BABYLON

Whether you work in one of our amazing offices or a distributed team, Babylon is highly collaborative and fun! You’ll have a chance to work in a fast-paced environment with experienced industry leaders. We have a learning environment where you can make an impact.

WHO WE ARE

We are a team on a mission, to put accessible and affordable healthcare in the hands of every person on earth. Our mission is bold and ambitious, and it’s one that’s shared by our team who shares our values, to dream big, build fast and be brilliant. To achieve this, we’ve brought together one of the largest teams of scientists, clinicians, mathematicians and engineers to focus on combining the ever-growing computing power of machines, with the best medical expertise of humans, to create a comprehensive, immediate and personalized health service and make it universally available.

At Babylon our people aren’t just part of a team, they’re part of something bigger. We’re a vibrant community of creative thinkers and doers, forging the way for a new generation of healthcare. We’re only as good as our people. So, finding the best people is everything to us. We serve millions, but we choose our people one at a time

DIVERSITY AT BABYLON

We believe that difference inspires a better, healthier world. That’s why it’s at the heart of everything we do. From our people to our products, difference enriches every part of our business and creates a culture based on equality of opportunity, and in which all Babylonians can progress their careers. We’re committed to creating an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, colour, religion, sex, pregnancy status, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, and any other characteristic protected by applicable law.

Nurse Case Manager

locations

• Portland, OR
• Remote, USA

time type Full time

job requisition id REQ003818

At The Standard, you’ll join a team focused on putting our customers first.

Our continued success is driven by a high-performance culture. We’re looking for people who are collaborative, accountable, creative, agile and are driven by a passion for doing what’s right – across the company and in our local communities.

We offer a caring culture where you can make a real difference, every day.

Ready to reach your highest potential? Let’s work together.

JOB PURPOSE

Assess claimants’ medical conditions, diagnostics, procedures performed and ongoing treatment to determine functional capacity levels as well as the appropriateness of care. Collaborate with treating physicians to promote suitable care plans directed toward return to work by communicating with claimants, treating and consulting physicians, employers and benefits personnel. Assess medical record documentation for completeness. Coordinate claim prevention, intervention and return to work programs for employers.

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

Contribute to the company’s success through excellent customer service and meeting or exceeding performance objectives for the following major job functions:

• Evaluate medical history and treatment and test results during file reviews and consultations with ision benefits staff. Provide assessments of claimants’ functional capacity and their levels and expected durations of impairment. Identify and resolve stated limitations inconsistent with medical documentation. Assess medical records to determine if claim for disability is caused or contributed to by a limited or excluded medical condition.
• Assess adequacy and appropriateness of treatment. Advocate on behalf of the claimant for appropriate services and treatment to attain maximum medical improvement and successful return to work. Work in conjunction with vocational and benefits staff to assess claimants’ psychosocial, environmental and financial status. Communicate with claimants, their families, employers, medical treatment providers, rehabilitation counselors and other carriers such as workers’ compensation providers or HMO’s, to ensure understanding of and cooperation with the recommended treatment plans and the goal of returning to work.
• Provide claim prevention services by working with employers to evaluate their organizations’ trends in disabilities. Coordinate site visits and assessments; advise on educational programs for employee groups; work in conjunction with vocational staff to recommend job site modifications and safety or procedural changes. Collaborate with sales, underwriting, and vocational and benefits staff to recommend, develop and implement intervention and return to work programs and practices for employers.
• Develop and conduct medical education and training for ision claims personnel.

ESSENTIAL FUNCTION REQUIREMENTS

Demonstrated skills: Effective case management. Effective identification and resolution of problems. Clear and persuasive expression of ideas in both written and oral communications. Effective collaboration with peers and team members.

Ability to: Utilize computer software and hardware applications. Talk by telephone. Shift priorities to meet demands from various customer groups. Make decisions in the absence of specific direction. Facilitate group discussions. Achieve professional designation.

Working knowledge of: Assistive devices needed by people with disabilities. The Americans with Disabilities Act, family leave laws, Fair Claims Settlement Practices Act, and laws governing client confidentiality.

QUALIFICATIONS

Education: BS or MS in a related field.

Experience: A minimum of 4 years hospital or clinical experience in relevant medical fields (e.g. cardiology, orthopedics, mental health) or utilization review or quality management, or the equivalent combination of education and/or relevant experience.

Professional certification required: Current Registered Nursing license, with a CCM or CPDM designation or ability to obtain such a designation within 2 years of hire. Is a job requirement

#LI-REMOTE

Please note – the salary range for this role is listed below. In addition to salary, our package includes incentive plan participation and comprehensive benefits including medical, dental, vision and retirement benefits, as well as an initial PTO accrual of 164 hours per year. Employees also receive 11 paid holidays and 2 wellness days per year.

• Eligibility to participate in an incentive program is subject to the rules governing the program and plan. Any award depends on various factors, including inidual and organizational performance.

Salary Range: $71,000.00 – $104,000.00

Standard Insurance Company, The Standard Life Insurance Company of New York, Standard Retirement Services, Inc., StanCorp Equities, Inc. and StanCorp Investment Advisers, Inc., marketed as The Standard, are Affirmative Action/Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, gender identity, sexual orientation, age, disability, or veteran status or any other condition protected by federal, state or local law. The Standard offers a drug and alcohol free work environment where possession, manufacture, transfer, offer, use of or being impaired by an illegal substance while on Standard property, or in other cases which the company believes might affect operations, safety or reputation of the company is prohibited. The Standard requires a criminal background investigation, employment, education and licensing verification as a condition of employment. All employees of The Standard must be bondable.

Senior Investigator (Healthcare Fraud)

Job Locations US-Remote

ID 2023-9775

Category Fraud, Waste, & Abuse

Position Type Full-Time

Overview

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role. This position may be worked remotely from home anywhere in the US.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review.
• Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
• Conducts investigation-related training.
• Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
• Negotiates settlement agreements to resolve disputes.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participates in special projects as required.

Qualifications

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 5-8 years of related investigative experience.
• Advanced level skills in Excel.
• Excellent verbal and written communication skills.
• Strong listening and observation skills.
• Attention to detail and high level of accuracy.
• Effective organizational and prioritization skills with multi-tasking ability
• Preferred certifications:
  • Accredited Healthcare Fraud Investigator (AHFI),
  • Certified Fraud Specialist (CFS),
  • Certified Fraud Examiner (CFE),
  • Certified Forensic Interviewer (CFI), or
  • Certified in Healthcare Compliance (CHC).

Job Demands:

• This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).
• Must be able to sit and use a computer keyboard for extended periods of time
• Travel up to 15%
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)

Base compensation ranges from $64,500 to $85,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

#senior

#LI-JB1

#LI-Remote

Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes iniduals based on their qualifications for a specific job. Cotiviti values its erse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Pay Transparency Nondiscrimination Provision

Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to iniduals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Virtual Psychiatric Nurse Practitioner (Full-Time) (California Licensed)

Remote

Role Summary: As a Psychiatric Mental Health Nurse Practitioner at Tia, your role in this transformative healthtech company will be foundational in setting the tone for the mental health care delivered at Tia. You will work closely and collaboratively with a growing multidisciplinary team of Therapists, MDs, NPs, and Acupuncturists in a virtual primary care setting ensuring optimal patient care. You will conduct responsible and compassionate psychiatric assessments, diagnosis, treatment planning, medication management, and referrals. You will also work cross-functionally to weave the mental health perspective into our educational offerings, supporting the clinical team in case consultation, health education / guidance, quality and policy development through collaboration and staying abreast of current trends and best care practices.

A bit about you:

Values and abilities you’ll bring to Tia:

• You’re motivated to elevate women’s care by bringing a shared-decision making approach to women’s health.
• You believe that each woman knows her body best, though she may need help interpreting what the signs mean. Your mission as a woman’s healthcare provider is to help your patients understand those signs and develop robust, multi-faceted treatment plans to reach health goals. You practice this by being a true partner on a patient’s health journey, never dogmatic, rigid or glued to institutions.
• You are an incredibly good question-asker & prober, this allows you to identify nuances of a patient’s life that could be pertinent to their story. You’re like a detective — but you do this with an elegance that makes the patient feel at ease sharing deeply personal information.
• You’re facile with technology, comfortable and experienced providing high quality care digitally via telemedicine and interested in the process of developing new technology to support the highest quality clinical care..
• You’re data driven and consistently incorporate new and evolving research into your day-to-day practice
• You’re a high functioning multi-tasker who has an incredible ability to stay calm and focused under pressure – this is a given – you are a NP after all! .
• You are a tolerant and inclusive thinker. You believe in sex-positive, no judgement and radically inclusive healthcare for every person, and espouse these values in your everyday life.

Skills and assets you’ll bring to Tia:

• You’re a board certified Psychiatric Mental Health Nurse Practitioner with an active and unrestricted license in the state of California, able to provide patient centered mental health and psychiatric care with compassion and empathy. While experience providing virtual care in the past is not a must – it is highly desired!
• At least 2 years post graduate clinical experience.
• Confidence prescribing, titrating, refilling, and monitoring psychotropic medications in all 5 major classes (anti-anxiety agents, antidepressants, antipsychotics, mood stabilizers, and stimulants)
• Experience with the following: Adjustment disorders, anxiety, depression, trauma, personality disorders, substance use and dependence, cognitive impairment, bipolar spectrum, attention-related disorders, postpartum depression, schizoaffective disorders, sleep disorders, and acute psychosis
• Knowledge and expertise in facilitating extended mental healthcare interventions in the greater NYC-area, greater LA-area, greater SF Bay Area or greater Phoenix area (ie. referrals and social service resources)
• Documentation skills requirements for an accurate and complete medical record
• Collaborate closely with MH and NP Leads to identify and support high-risk patients
• Exceptional written and verbal communication skills.
• Demonstrated excellence in Interpreting and act on clinical labs + ultrasound results
• Willingness to work evenings + weekends as needed by schedule
• Authorized to work in the US

Other nice to have skills:

• As an organization that seeks to create an environment for all women to feel safe, heard, recognized and avowed in their health, bodies and lives, we are consistently seeking providers with backgrounds that are meaningfully different from those already forming our team. You bring a erse background, a range of care experiences in different communities or various modalities.
• Formal professional training in the following areas is highly valued: care delivery for women who have experienced trauma including having a lived experience of abuse,, decision making support for low-income women, care delivery for LGBTQ identified folks, care delivery for immigrant or migrant or english-as-a-second-language support populations.
• A strong understanding of & interest in chronic stress and trauma as it relates to immune system compromise and inflammatory response systems is a plus.
• Experience or formal training weaving integrative medicine practices into your care plan development.
• Contracted with major payers (BCBS / Anthem, Cigna, Aetna, United)

Tia requires that Nurse Practitioners complete credentialing with specified payors and that you authorize Tia to complete this credentialing through our preferred vendors.

Benefits

• Talented and collaborative team who will both support and challenge you.
• Remote role with flexibility to work from home
• Market competitive salary
• Annual CME stipend
• Medical and dental benefits
• Paid holidays, vacation, and sick leave

Per California Pay Transparency Laws (as of Jan 1, 2022), please see below for the compensation range for this role:

Salary range: 140k-160K depending on experience for a 40 hour a week (FT role) plus performance-based bonuses.

Internal Auditor II – Hospital Coding

Apply

locations

Sacramento

Remote – Utah

Remote – Texas

Remote – Tennessee

Remote – South Carolina

View All 17 Locations

time type

Full time

posted on

Posted 7 Days Ago

job requisition id

R-39401

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

This Compliance Auditor role will have primary responsibility for leading a variety of independent assurance and consulting projects covering the operational, regulatory, and reporting processes of Sutter Health and its Affiliates’ functions related to Hospital Coding.

Responsible for assisting in advancing the departmental mission in a manner consistent with the values and standards of Sutter Health, the Department and the internal audit profession. Responsible for familiarizing themselves with the annual work plan, researching relevant topics to carry out assigned project areas and fostering important strategic relationships with other functions and affiliates. Participates in improving the efficient and effective delivery of the Department’s assurance and consulting services including promoting the departmental brand.

Job Description:

• This role is in the Ethics & Compliance Team and involves hospital coding.
• Candidate must be a certified coder (CPC or CCS) to be considered for this role.
• Canidate must live in the Northern California Sutter footprint and come on site as needed for meetings, etc.

EDUCATION:

Bachelor’s: Degree in Accounting, Auditing, Finance or other Business Administration area. or equivalent education/experience

TYPICAL EXPERIENCE:

• 2 years recent relevant experience

DEPARTMENT REQUIRED CERTIFICATION & LICENSURE:

• Department: Coding Audit, CPC-Certified Professional Coder
• OR Department: Coding Audit, CCS-Certified Coding Specialist

SKILLS AND KNOWLEDGE:

• Knowledge of internal audit leading practices and computerized auditing techniques.
• General knowledge of Institute of Internal Auditors (IIA) Standards for the Professional Practice of Internal Auditing.
• Advanced analytical and project management skills, including the ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.
• Able to display a high degree of professionalism and leadership.
• Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex technical or sensitive information related to audit activities clearly and professionally to erse audiences.
• Proficient computer skills, including a working knowledge of Microsoft Office Suite (Word, Excel, Outlook, Access), Microsoft Visio or other flowcharting tool, audit software applications.

Ability to:

• work independently, as well as part of a multidisciplinary team, while demonstrating excellent organization skills.
• managing multiple priorities/projects simultaneously, sometimes with rapidly changing priorities
• maintaining audit schedule
• meeting tight and often conflicting deadlines
• analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems.
• maintain strict confidentiality and ensure the privacy of each patient’s protected health information (PHI).
• build collaborative relationships with peers, other departments, stakeholders, and external agencies.